The Heart Specialist

by Claire Holden Rothman

  George’s eyes narrowed.

  “He likes me, George. He’s sincere enough about that. But it goes no further.”

  “You said he gave you his ring.”

  “Yes, but only because all the men were doing it — giving rings and photos with endearments scribbled on the back to their girlfriends. If the others hadn’t done it the thought wouldn’t have entered his mind.”

  “So he’s a conformist?”

  “No. Just the opposite in fact.”

  “I’m afraid I’m not following.”

  I inhaled and tried again. “Most of the time Dugald Rivers is himself. And that self is perfectly content to converse and eat tarts in the museum. But the war brought certain pressures. Many of the men have sweethearts to write to. Dugald decided to fit me into the mould of a sweetheart. There’s a certain logic to it. He has such trouble fitting the conventions that he felt obliged to give me that ring. It was so awkward. It felt like play-acting.”

  George Skerry raised her eyebrows. “He sounds like an invert,” she said quietly.

  Inversion: the crime of sexual love between men. The medical profession considered it a pathology. Yet the book I’d read over in Oxford, the one by Iwan Bloch, had been tolerant of the practice.

  “I am not sure what Dugald is,” I said finally. I had never discussed Dugald’s sexual life with him and felt uncomfortable speculating about it, even with an intelligent and sympathetic person such as my old governess. “He’s just himself, George.”

  Miss Skerry smiled. “Fair enough. Besides, he writes gems of letters.” She made a few more stitches before looking up again. “Aren’t you going to read it?”

  I opened the envelope, which bore a November postmark. Mail took excruciating lengths of time to reach Montreal, having first to cross the U-boat-infested Atlantic and then be put on a train in Halifax. The letter began “My beloved,” a fact I decided not to share with Miss Skerry or my sister, who was beside us on the sofa clicking steadily with her needles.

  Dugald’s first paragraph was devoted to rain. The Picardy sun was apparently in retreat. The most pressing medical challenges now were rheumatic fever and pneumonia, which had ravaged the beleaguered hospital staff. Dugald himself was suffering from asthma. Although the hospital was now empty of wounded soldiers the medical staff had been instructed to stay on until further notice, no matter how bad conditions became.

  Their tents were in tatters. They had been a gift from India, a country whose tent makers had no idea how dismal a French autumn could be. They had begun to disintegrate in the first autumn rains. The cotton ropes anchoring them shrank, pulling the pegs out of the earth. The canvas split. Mud oozed through the floorboards and rain poured in, soaking bedding and clothes. “They’ve closed the hospital!” I exclaimed, looking up. “It was deemed unfit for habitation!”

  Dugald had decided to leave for the front. Most of the young men, including Revere Howlett, wanted to do the same. Jakob Hertzlich, who was older, had opted for England, where he was trying to get work as a hospital orderly. No one, it seemed, considered the possibility of returning home.

  “They’re throwing away their lives,” said George Skerry.

  I stared at her. Hers could be an irritating frankness.

  “It’s true,” she continued. “Bad enough some countries force their men to fight. These young men are leaping to their deaths of their own free will.”

  “I’d leap too if I could,” I replied.

  George Skerry looked at me. “Nonsense. Don’t you see how blessed we are? Don’t you see that war is one of those rare times when womanhood is a privilege, not a curse?”

  She gave me pause. The war had been good to me professionally, it was true, but it had almost destroyed my personal life. Aside from George Skerry there weren’t many women whose company I enjoyed. I was often lonely. I missed Dugald Rivers, Dr. Clarke, even Mastro. I missed my students, and — I couldn’t believe I had been so reduced — I would even have been pleased to see Jakob Hertzlich again.

  “Look at us,” George went on, “warming our feet by the grate while our young men are dying on foreign soil.”

  Laure looked up blankly from her stocking. I had to smile.

  “Agnes,” Miss Skerry said briskly. “Our work is for the first time in history valued and in demand. Look at yourself, my dear. Think of all you have accomplished in the past year. Without the war Harvard would not have invited you.” She paused, seeing the look on my face. “Not for want of talent. You know that. But under normal circumstances Harvard would invite a man. The war has offered you opportunities. You have seized them and shone.”

  I glanced at the socks lying on George’s lap. They were expertly knitted, not a stitch loose or out of place. Some boy George Skerry had never met would likely die in them. She rewound what was left of the skein to replace it in the knitting box. Her argument fell down with her own life. She couldn’t claim that the war had benefited her in any way. She was living out her best years in seclusion with Laure, knitting socks for corpses.

  That night after we had put Laure to bed I stopped her, putting my hand on her sleeve. “You’re not bored here, are you George?”

  We were in the upstairs hall outside Laure’s room. George drew back physically. Bathing Laure or even restraining her was one thing — it was part of her job — but a gesture of intimacy between equals was a different story. “Boredom is for boring people,” she said hastily.

  I sighed. She occasionally slipped back into being my governess, distancing herself with aphorisms. I tried one last time as we headed down the stairs. “Don’t you dream of more?”

  She looked up, eyes magnified by her lenses. Her gaze was so direct I had to drop my own. I moved toward the stairs, giving my old friend a moment to collect herself. In the parlour the fire had shrunk to a heap of ash-covered coals. George Skerry knelt beside it and blew, coaxing out a flame. It was obvious that she did not wish to speak so I went to the bookshelf. The number of books had grown since Miss Skerry had moved back. My old governess picked up her edition of Virgil and sat down on the sofa. She was wading through Book IV, the incendiary passions of Queen Dido.

  About half an hour later the fire again began to dim and George rose to her feet. “You must have learned by now, Agnes, that it’s not possible to judge a life from the outside,” she said. Her voice had an edge. “One inevitably gets it wrong.” Miss Skerry’s face was half-turned from me and tinted by the firelight, making her expression difficult to read.

  “I didn’t mean to criticize you,” I said. “Just the opposite.”

  There was a long pause and when George spoke again her voice was gentler. “I’m happy here, Agnes. I have my pleasures.” She patted the worn cover of her book. “I am among people to whom I feel close.” Her voice wavered slightly. It might have been fatigue or smoke in her throat, or it might have been emotion.

  23

  AUGUST 1917

  Afternoon light poured in through the window. It lit up the papers arranged on the floor around me. It spread over the table cluttered with jars and wax reconstructions, X-rays and charts. It coloured the skin of my hands and neck, and my forehead etched from hours of classifying. The heat was strong; I rocked back on my heels and leaned into the shade.

  I stood to pull the blind and my knees almost buckled. While I worked I often forgot about my legs tucked beneath me. They felt dead. I propped my bottom on the rim of a lab stool and unbuttoned my collar. The little room on the top floor of the new Medical Arts Building was directly beneath the copper roof. It trapped the heat.

  No one else was so obstinate as to work on campus through the months of July and August. Most of my colleagues were overseas, but even those who had remained in Montreal fled the city for the summer. Awful old Dr. Daimler, who had replaced Dr. Clarke as acting head of the medical faculty, hadn’t shown his beaky face all July. I should count my blessings, but the secretaries were gone too, which I regretted. I liked to visit them and chat on breaks.
At the moment even the janitor, a man named Cook whom we all called “the King” because of his self-possessed airs, was on holiday. People would start returning in a week or two, although there was hardly any urgency. The incoming class was tiny. If the war dragged on much longer, which it gave every indication of doing, the medical faculty would be forced to let in women. Perhaps there had been something after all to Miss Skerry’s opinions.

  I made it a point of honour to arrive at McGill each morning at eight o’clock and put in a full day’s work. It lent shape to my life. There was plenty to do. I had just completed a pamphlet on Florence Nightingale, who had died recently at the age of ninety. A publishing house in London had shown interest, especially after I suggested that all the proceeds could go to the Red Cross. I’d accepted an invitation from the New York Academy of Medicine to give a talk at the end of the month. In the United States I had become something of a celebrity. My fame had spread, I suspected, largely by default. There were few scientists left on Canadian soil and I stood out as one of a handful of people continuing to do original research.

  The talk I had planned was ambitious, the culmination of my years of research. I had gathered the specimens I used in my teaching and for publications. I was planning something entirely new. The traditional reading of dusty reports no longer interested me. I wanted to shake my audience and make them sit up.

  What I had fashioned was a travelling show about the heart, designed to appeal to the senses instead of merely the mind. I had material to fill eight sheets of grey millboard, occupying wallspace four feet by thirty-two feet high. Awkward for travel, but once I’d set up it would take the breath away.

  Strewn at my feet were my treasures: a collection of Jakob Hertzlich’s sketches of cardiac anomalies, forty-two photographs of specimens, twenty-four radiographs, a number of tracings, seventeen charts and twice that number of diagrams. On the table were fifty specimens suspended in their jars, showing the most common defects and anomalies, as well as a handful of reptilian and piscine hearts to show the evolutionary and ontological course of development. In cases where I had no specimens I had made wax reconstructions.

  Leaning against my desk was a chart of statistics indicating the special features of a thousand cases of congenital heart disease and necropsies. This material had originally been published in Howlett’s textbook and was the cornerstone of my fame. But now I would build further. I was not simply a researcher — “Howlett’s lackey” Jakob Hertzlich had once called me — compiling the results of his work in his shadow. Now I would step out on my own. I would do so in style.

  Among the sheets scattered on the floor was a flyer announcing my talk. Heart Specialist, it read, giving my name and academic degrees. The advertisement would be published in major American newspapers on the eastern seaboard. Thousands of people would receive copies, one of whom might be my own missing father. Of course my name had changed, but surely he would recognize his wife’s maiden name and the Christian one he had given me. I had no idea where he was living. I had inquired about him at the medical schools in Canada and at the major ones in the United States, but without result. He had probably set up a practice in a small town in the Boston area, to which many French-Canadians had migrated. I believed he was still practising. Medicine had been his life.

  Whenever I published an article or saw my name in print like this on the flyer I felt a surge of hope. Honoré Bourret might see it. It was my life’s dream.

  On the table beside me were a collection of case studies, neatly typed and ordered. I would take my audience by the hand and lead them through the process of a diagnosis. Doctors were still astonishingly ignorant when it came to deciphering murmurs and trills. In my years of clinical practice and observation I had discovered that the path to understanding the heart lay in its sounds. Finer diagnostic tools would one day be developed, but right now the best I could do was listen. Of course the electrocardiogram was making headway. There was one at the Montreal General Hospital — but for the moment not a single doctor there knew how to use it. The human ear was still the best tool. If a person took the time to listen the heart would eventually offer up its secrets.

  My first case study was a boy of six, admitted to hospital with a swelling in his neck. The swelling had had nothing to do with his heart — it turned out to be a tubercular node — but the instant I had placed my ear on his chest I had known. There were no outward signs. No clubbing of fingers, no tint of skin. His lung fields were clear and the blood pressure normal. But as soon as my stethoscope touched him it revealed the terrible verdict. The murmur was harsh, echoing against his narrow ribs. It reverberated over the entire pericardium and both scapulae. Upon his death two years later my diagnosis was confirmed. The hole in his ventricular septum was the size of a nickel.

  The second case involved a girl of fourteen whose parents had consulted me. She had visible birth deformities: a bent spine and clubbing of one foot. Her early development had been normal but shortly before their consultation with me the parents had noticed that the girl’s lips turned blue when she ran or walked vigorously. She was a small child, underdeveloped for her age and still prepubescent. There was no generalized cyanosis, no clubbing of the fingers or difficulties with breath. Midchest, however, I heard the clicking and diagnosed her on the spot.

  The nurses at the hospital called me a witch; little was known about the heart and my diagnoses seemed like sorcery to them. All I did was to look and to listen. What others called magic was the careful, practised use of my ears and eyes.

  Once a diagnosis was made, of course, there was nothing I could do. Such was the problem with cardiac anomalies. Cures were nonexistent. My patients were doomed to short lives of pain. The boy with the ventricular septal defect had been eight years of age when he died. His heart was now bottled and shelved. In time, provided her family consented, I would take the girl’s.

  I looked briefly up from my notes. I was surrounded by hearts, sectioned and preserved. Hearts with holes. Hearts with leaking valves or thickened walls. Hearts with narrow or transposed aortas. I closed my eyes.

  When I opened them the dean’s secretary was standing in the doorway. Over the last few years I had come to know Mrs. Greaves more intimately. She was a widow whose husband had died years ago during the infancy of their only child, a red-haired boy named Alexander. Now Alexander was in Flanders. He had been part of the victory at Vimy Ridge in April. More recently he had fought at Messines. He was still alive. Apart from Alexander Mrs. Greaves had but one sister who was a nun. She was alone like me. And like me she had shown up for work every day of this hot summer. She had not, to my knowledge, indulged in one day of sick leave. Every time she received a letter from her boy she climbed the stairs to the museum to share it. Alexander didn’t write half as well as Dugald Rivers, but I rejoiced over his letters just the same, encouraging his mother to share the four or five scrawled lines with me over a cup of tea.

  Today Mrs. Greaves was wearing a blue smock-like dress. Her face was puffy. “Mail’s arrived,” she announced, holding out a letter.

  I made out foreign stamps and the looping script of Dugald Rivers. “Did you get one?” I asked, taking mine from her.

  Mrs. Greaves shook her head.

  I had not read Dugald’s letters aloud to Mrs. Greaves but the woman in the doorway looked so forlorn I decided I should. I checked the postmark. The third of July. It had taken over a month to reach me.

  “Terrible, the waiting,” said Mrs. Greaves when I showed her. “Even when you get a letter you can’t be sure if they’re alive.”

  I nodded. This was something I didn’t like to think about.

  “My neighbour’s boy was at Ypres. Second battle,” Mrs. Greaves went on. “The Army sent a telegram informing her he’d been killed. Two weeks after that a letter arrived from him announcing his good health.” She paused. “It’s enough to do a person in.”

  I put a hand on Mrs. Greaves’s shoulder. Before the war I would not have invited this
woman for tea, let alone touched her. Now she was a friend. “Let’s see what dear old Dr. Rivers is up to,” I said, diverting my guest by unfolding the onion-skin sheets. The letter was long, written in a hand that seemed spikier than Dugald’s usual flowing script. At the moment, he wrote, he was in a hospital in London sleeping on an honest-to-God mattress between real cotton sheets, bathing in hot, clean water and eating food other than bully beef and wormy biscuits. That was the good news.

  Mrs. Greaves’s jaw sagged. “Don’t tell me he’s been hit.”

  He was intact, he wrote, but barely. His lungs were ruined. His battery had taken gas at Passchendaele, and that, combined with the interminable rain, had done him in. He’d suffered bouts of asthma so bad no one thought he would survive.

  My own chest squeezed tight. For over a year Rivers had been divulging horrors so awful I had few remaining illusions about the sanity of war. He had described how German machine guns had mowed down battalion after battalion of Allied boys. The Canadian men had only rifles, and poor ones at that, with the fatal habit of jamming in damp weather. Our young men perished in rows, caught in the act of loading or cocking. In one unforgettable letter he described the gas used by the German Army. It hung over the trenches in a yellow cloud and shredded men’s lungs. It blinded as well, but its primary target was the lungs, which filled with pus. Gas victims died horrendously, drowning in their own secretions. In all his years of practice, wrote Dugald, he’d never seen anything so ghastly.

  Few letters of this kind were reaching people back in Canada. Dugald was a particularly candid correspondent with an artist’s eye for detail. Although deeply patriotic and familiar with military culture he was a humanist before all else and the suffering to which men fighting on the Western Front were subjected appalled him. In the four years of the Boer War, he told me, a total of two hundred and twenty-four Canadians perished. The carnage of this current war was of a completely new order. Had his superiors ever suspected the contents of his letters I am certain he would have been censored. Fortunately for me he was clever enough not to give cause for suspicion. From the outside he appeared as quietly stoic as any other soldier.