The Surgeon: A Civil War Story

by Schwartz, Richard Alan

  The fact I’m a female doctor in a man’s profession causes constant frustration. As my team observed my surgical skills, they (reluctantly!) began to respect me. Unfortunately, most others don’t think I should be a doctor, let alone a surgeon in a war.

  Events grind me down as I suspect happen in all wars. I’m tired, both physically and mentally. If it wasn’t for the sense of duty you instilled in me, I’d have quit and come home long ago. Thank you.

  I’m enduring nightmares and have trouble sleeping. They don’t seem to go away and may be getting worse. Not sure what I’ll do.

  Bought some clothes recently. Nothing cheery. Just gray and black which allows me to get my job done and, sadly, reflects my emotional state.

  Abbey stood, walked to a window, and gazed at the busy neighborhood below. She returned to the desk and re-read the letter.

  “My God. This is my life?” she thought, then sat back and closed her eyes for a while. “Only Mom will appreciate what I’m going through.” Abbey crossed out her father’s name and addressed the letter to her mother and added instructions, the contents were for Myra’s eyes only.

  The doctor spent the balance of the day trying to sleep with the exception of evening meal which she ate in her room.

  * * *

  “Good morning,” Abbey said with a smile at breakfast on Wednesday. In a quiet voice, she asked, “How was yesterday?”

  “Wonderful,” Lt. Scharf replied. “I visited my grandparents’ old neighborhood in the morning and spent the afternoon reading. You?”

  “The day was great. Put together a letter to my mom.”

  They ordered breakfast. He sipped his coffee. “Yesterday wasn’t close to wonderful…”

  “You felt empty and alone.”

  He sat up straight and nodded. “I did…the whole damn day.”

  “Why?”

  “Not sure.” He twisted on his chair then said, “Missed my teammate. You?”

  Initially expressionless, Abbey just stared at him for a minute before dropping her eyes to her lap. With a slight smile, she quietly replied, “The same.”

  “Because?”

  “What we’ve endured as a team has brought us together like family.”

  “You’ve thought this through.”

  She nodded. “Loneliness is not a good feeling.”

  “What shall we do?”

  “Spend the day together doing anything as long as we…well…keep the team together.”

  A bumpy ride on a noisy trolley delivered them to a library. The twosome sat on couches and chairs; he reading a book on physiology and she an account of Dr. Ignaz Semmelweis.

  “Listen,” Abbey said. “This Hungarian physician discovered doctors washing their hands before they touched women in a maternity ward reduced mortality rates from ten- percent to less than two-percent.”

  “How did he determine the percentage?”

  “He compared the results of two clinics in the same hospital. The mortality rates in the first, where doctors performed autopsies before attending births, were higher than in the second which was attended by midwives and doctors who hadn’t done autopsies.”

  “What did they die of?”

  “The mortalities were due to post-partum infections which developed within twenty-four-hours of birth. Dr. Semmelweis discovered women delivering babies on the street rarely developed the infection.”

  Lt. Scharf became pensive for a while then asked, “We see numerous infections after surgery. Could it be due to dirty hands…or instruments?”

  “I’ll keep reading and let you know.”

  Thirty-minutes later, the lieutenant asked, “What did they wash their hands with?”

  “Chloride of lime in solution.”

  “Why would it make a difference?”

  “No one’s figured it out but the difference is rather dramatic.”

  They looked at each other.

  Abby said, “Our after-surgery death rate was near forty- percent at the beginning of the war. Applying the lessons of the Crimean War, we have it lowered to around twenty-eight- percent for primary amputations. If we could lower those by eight-percent…”

  “Let’s find chloride of lime and take it back to camp.”

  “I’ve been reminded our patients aren’t experiments,” Abbey cautioned.

  “If we find one thing which helps them…”

  “We’ll see. When casualties mount, I don’t see how we’ll have time.”

  “We could try a technique one time and follow the patient.”

  Abbey leaned back and stared at the high ceiling. “Dr. Semmelweis achieved an eight-percent reduction in mortality. If we achieved the same…” The doctor turned to her assistant.

  “We’d be heroes,” he said.

  She nodded.

  “Perhaps we could try some things with gangrene…like additional cleanliness.”

  Abbey leaned back, became pensive then said, “Before I treated each of the first two of the gut-shot wounds, I washed my hands and cleaned my instruments as I thought we were done for the day. While I was working on the second, the next two arrived so I didn’t clean the surgical tools before operating on the third and fourth soldiers.”

  “Were the first two soldiers you treated the men who survived?”

  She nodded.

  “Then when we’re back in camp, we’ll make a plan to try some things.”

  They were quiet for a while when he stated, “I was reading about autopsies where pus was discovered in the blood stream resulting in an always fatal condition.”

  “I need to spend more time with my microscope to observe similar conditions. When did you read about pus in the blood?”

  “A couple months ago.”

  “You must have a mind like a steel trap.”

  He shook his head while stating, “Dr. Fellows and you keep giving me more responsibility during surgery. I make a mistake due to lack of knowledge and I kill someone. I’d rather study hard enough to remember what I’ve read.”

  They concentrated on their books for a few hours then Abbey asked, “Hungry?”

  He nodded.

  They found a butcher who sold brisket sandwiches then continued walking.

  “How did you sleep last night?” he asked.

  She shrugged. “Barely.”

  “Nightmare?”

  “One early in the night then couldn’t sleep the rest of the night thinking of all the soldiers we couldn’t help or died on the operating table.”

  “Try push-ups.”

  She laughed.

  As dinner ended, Abbey sipped the last of her wine, pulled him close, kissed his cheek and whispered. “I want my teammate to share my bed tonight.”

  Thursday morning, they found a bookstore. Each made a purchase. A kosher deli provided lunch. The afternoon was spent in his room; Abbey read on a couch, he studied at a desk. Eventually, Abbey nodded off. He covered her with a blanket and returned to his book.

  After dinner, they sat on the veranda of the hotel and watched the sun go down.

  “Nightmare last night?” he asked.

  “Only one and it was mild so was able to get back to sleep.”

  He cleared his throat. “Dr. Kaplan, this week has been a great relief…being away from the constant tension of the war…”

  “Makes one almost feel human.”

  He laughed.

  A cacophony of nighttime insects came to life as the remaining daylight morphed into darkness. “Time for sleep,” she said.

  They both stood. Abbey briefly embraced him. “Thank you.”

  He slid his arms around her. “For what?”

  “Listening to me, learning enough surgical technique to assist me. Protecting me during battle. Closing my wounds. Encouraging me to keep going despite Dr. Fellows criticism. Doing your best to see I’m treated with respect…I could go on but you know.”

  “Abbey, the things you mentioned, are the least I owe you for directing my studies to help the wounded.”
<
br />   “Which would have amounted to little without your hard work. You’ve been an outstanding assistant surgeon’s assistant.”

  He laughed and said, “My pleasure.”

  Abbey leaned into him and kissed his cheek. “Assistant, keep me warm again tonight.”

  Friday was filled with walks along the river and occasional conversation.

  After a pleasant dinner they returned to Abbey’s room. He stood in front of her. “This week…”

  They stared into each other’s eye’s.

  “I know,” Abbey said. “We’re two lonely people who’ve been thrown together and forced to endure bloody horrors. One or both of our lives might end in a fraction of a second. I don’t want to get close to anyone I might lose.”

  He sighed. “As usual, you’re right. Besides, a relationship based on mutual loneliness wouldn’t last.” He forced a smile. “It’s been a good week. Thanks for accompanying me.”

  “It was…a good week.”

  He turned to leave.

  Abbey tucked a lock of hair behind her ear. “Wait.”

  Lt. Scharf looked back at her.

  She stepped toward him and put her arms around his neck.

  “One more night together, please.”

  Lt. Scharf embraced her. He kissed her lips. Abbey wrapped herself around him as tight as she could.

  On the train back to camp, he said, “The closer we get, the more anxious I’m becoming.”

  She sighed. “I sense the same.”

  Evaluations

  At the recovery hospital, Drs. Kaplan and Fellows examined patients in a large ward and determined a few would need further surgical intervention.

  “Hey you,” a young lieutenant called to Abbey. “I need some help over here.”

  She ignored him.

  He shouted, “Hey You, I’m Doctor Peter Dillon and an officer. I’ll make your life hell if I don’t get a response when I talk to you. I need to talk to Dr. Kaplan.”

  A number of nurses in the ward turned to watch Abbey.

  Unsmiling, she walked up to him, put her hands on her hips and glared down at the slightly more than five-foot-tall man. She spoke slowly and succinctly. “I’m Dr. Kaplan. Not, Hey You. Please rest assured, you won’t be giving me or anyone else hell, little man, or your first medical intervention will be to remove the boot I’ll bury in your ass.”

  A number of nurses turned away, covering their mouths to stifle laughter.

  His cheeks reddened. In a trembling voice he said, “I’ve been assigned to your team for training before I’m sent to a regiment.”

  “We’ll be performing two surgeries shortly. I’ll be leading today, so you stand next to me and observe.”

  He swallowed hard. “Yes, Doctor.”

  After the surgeries were complete, Abbey told the newcomer, “Head to the kitchen and get a ten-inch-square of pork belly with skin attached. We’ll begin your training by cutting and sewing the pork.”

  A nurse, standing next to a man on crutches, called to Dr. Kaplan. The doctor crossed the ward. The nurse lifted the patient’s shirt. Abbey removed a large, square bandage and examined a burned area the size of a dinner plate.

  Dr. Dillon whispered to Dr. Fellows, “Excuse me Major, but will I have to take orders from a woman at my new regiment?”

  Dr. Fellows squinted at the newcomer. “I’m forced to put up with her on a daily basis, so you’ll manage to follow her orders while being trained.”

  “Work for a woman? I’m more of a man than that.”

  His eyes glaring, Dr. Fellows said, “I’ve noticed the team emptying bed pans is short staffed. I can arrange your assignment to use your medical education to perform that duty…if you prefer…”

  The newcomer appeared horrified, gulped, then spat out, “No,” quickly adding, “Major.”

  Putting his hands on his hips, Dr. Fellows said, “Then I suggest you learn to follow Dr. Kaplan’s orders.”

  The soldier swallowed hard and said rapidly, “I can follow her orders, Sir.”

  Abbey talked to the nurse and burn victim, “Keep it clean and it should continue to heal.”

  Dr. Dillon approached Abbey. “A ten-inch-square of pork belly with skin attached. On the way, Doctor Kaplan.”

  Abbey spent the next two-hours working with the new arrival. He was sent back to the mess area for more pork to practice on.

  She shook her head while examining Dr. Dillon’s attempts to duplicate her technique.

  Abbey found Dr. Fellows staring out a window in an office they’d been assigned. He offered her a drink.

  “No thank you.”

  He lifted his glass and downed a large swallow of dark liquid. The elder doctor coughed once then wiped his lips with the back of his hand.

  Abbey rolled her shoulders a few times, attempting to relieve stress then sat in a chair and folded her hands in her lap. “He doesn’t have sufficient dexterity for surgery.”

  “How bad?”

  “Dangerous bad. One glance at his work and you’d think he wore hams at the ends of his arms instead of fingers. He can barely cut a straight line and has little ability to suture. Most of his incisions were irregular and too shallow or too deep.” Abbey closed her eyes and shook her head. “Although his book knowledge may be adequate, the man shouldn’t be allowed anywhere near a patient needing surgical intervention.”

  “I’ll send a letter to the medical board but it’s not our decision.” He downed another belt then briefly stared at her. “On the other hand, you like paperwork. You send them a letter.”

  Using more sarcasm in her voice than she intended, Abbey said, “Hitting the bottle kind of hard, Doctor?”

  His face reddened and he growled, “You think it’s easy for me to remove limb after limb from these young men?” He stared at the floor and shook his head then gave her a dismissive wave. “I don’t know how the hell you can remain so reserved.”

  “It’s our job.”

  He stood and began pacing. “For more than thirty-years, I enjoyed a quiet practice in a small town. If someone needed surgery I’d stop their bleeding and send them to a hospital.” He gestured toward the recovery wards. “Think of all those cripples. Who knew this damn war would endure for years instead of months? Now I’m mired in this…shit. I’ve witnessed enough horror for a hundred goddamned lifetimes. The cries and the terror in the eyes of those casualties will be in the forefront of my memory until the day I take my last breath.” He collapsed into a chair and stared daggers at Abbey. “Go back to the ward, Dr. Kaplan.” He refilled his tumbler. “If anyone asks for me, tell them you don’t know where I am.”

  “You trust my medical decisions?”

  “As long as you’re not performing experiments. If you feel the need…get my permission first.”

  * * *

  “Talia! Mrs. Warshawsky,” Abbey called out when she saw them just after camp disease treatment.

  “Dr. Kaplan, how are you?”

  “I just received a document specifying how to surgically repair a hare lip.”

  Talia’s eyes grew wide. With a hand covering her deformity, she yelled, “When?”

  “I’ve never done this so there’s no guarantee.”

  The young teen grabbed Abbey wrists and begged, “When?”

  “I’ll assemble my team. Be at the medical tent in an hour.”

  After the procedure, Abbey gave care instructions to Mrs. Warshawsky then added, “The stitches will fall out on their own. Don’t pull on them and keep the repaired area as clean as possible. Let me see her again in three days. Sooner if it becomes warm, red or the swelling increases.”

  Talia patted Abbey’s arm and tried to form a word but it was too painful.

  “I know,” Abbey said. “You’re welcome.”

  * * *

  “Excuse me. Are you Doctor Kaplan?” a slim young woman of medium height asked a few weeks later during breakfast near the field hospital tents.

  “I am.” Abbey downed the last of her cof
fee.

  “Pardon the interruption. I’m Margaret Herzog. I’ve sufficient medical training which qualifies me to become a surgical assistant but the only work I’m given is bathing patients and emptying bed pans.”

  “A surgical assistant requires a medical degree and completing an examination.”

  “I’m aware. If I can work with you and learn about camp disease and surgery, I’m certain I could pass the exam.”

  “Have you completed your medical studies?”

  “Completed both years but ran out of money, so didn’t receive a degree.”

  The doctor regarded the thin woman whose expression pleaded for help. “What do you propose I do?”

  “Assign me to your team. I want to put my book learning to use and become a surgeon like you.”

  Abbey looked away and said, “I have little control over assignments.”

  “I’ve heard surgeons can request personnel.”

  “Someone high up the chain-of-command assigned me to this regiment’s chief surgeon. Try asking your superiors.”

  Margaret’s posture stiffened. “They’re men who don’t think I should be here. As it happens, they don’t think you should be here either. They talk down to me and don’t listen. Sorry to have bothered you.” The woman’s expression was bitter as she turned to leave. She took a few steps. Margaret stopped, hesitated then spun around and glared at Abbey. Red faced, fists clenched, and body shaking, she shouted, “If a woman won’t help me, who the hell will?”

  Expanding Educations

  The sound of distant cannons followed by exploding shells rumbled across the sky. Abbey stared at the newcomer then wondered what her mother would do if faced with a similar situation. She smiled then tucked a lock of hair behind her ear. The doctor leaned back and sighed. “Get something to eat and we’ll talk.”