“The risk because of this…peritonitis?” Annie asked.
“Yes, you’ve got it. You see, from what I learned in my surgical gynecology classes, cysts can be life-threatening, becoming so large that they will damage other organs. However, some of these cysts will simply collapse after they are drained and won’t return. Others may grow so slowly that they won’t threaten a woman’s life for another fifteen to twenty years.”
Laura broke in, “So a woman may have to choose between living with the problem in the hope it won’t kill them versus the possibility of dying right away from the surgery? Heavens, what an awful choice.”
Annie said, “Yet, from what Dr. Brown told me, Mrs. Truscott’s cysts were growing rapidly and causing her both pain and embarrassment.”
Laura turned to her. “Why embarrassment?”
“Dr. Blair said Phoebe Truscott’s stomach had gotten so big that it looked like she was pregnant. I can only imagine that, as a newly married woman, this would have been particularly upsetting.”
“Oh,” Laura said.
Caro added, frowning, “The discomfort would have been quite considerable, as well. These notes say that the tumor itself weighed seven pounds, the fluid an additional twenty-three pounds.”
Annie thought Nate looked a bit sick at the thought of carrying thirty pounds of some foreign growth around inside him. Good thing he hadn’t had to carry a baby to term. To think this poor woman had to carry all that weight, without the hope of a child to make it bearable. No wonder Phoebe Truscott had decided to risk surgery.
Laura said, “So from what you two have read in these notes, would either of you have recommended surgery?”
Caro cocked her head and said, “I would lay out the pros and cons of both the surgical route and continuing with the expressions. Then I would leave it up to the patient to decide.”
Mitchell shrugged. “I don’t know. A lot would depend on the age and general health of the woman. In this case, the record says Phoebe Truscott is only twenty-one, awfully young to have to face decades of ill health and pain without the operation. However, there is also the question of whether or not a patient even understands the medical risks to surgical intervention.”
Mitchell picked up the form the Truscotts had signed and turned to Nate. “I think that you can certainly argue that, if the Truscotts actually read this form before agreeing to the surgery, the dispensary had done a good job of informing them of the risks.”
Nate said, “I agree. However, in my experience, where the reputation of professionals like Dr. Brown or institutions like the Pacific Dispensary are concerned, the legality of an action is not as important as the public perception of wrongdoing.”
Annie said, “In short, if the doctors associated with the dispensary, or the dispensary itself, developed a bad reputation because the Truscotts sued them, then people like the former treasurer, Mrs. Branting, and her wealthy friends wouldn’t want to be associated with it. And if they withdrew their monetary support, this would further hurt the dispensary.”
Mitchell said, “That’s it exactly, Mrs. Dawson. Let me tell you a story about how serious the question of malpractice, specifically regarding the question of infections, can be. You all have read, no doubt, about how some people are blaming the death of President Garfield on his physicians?”
Laura leaned in, eyes shining with interest. “Yes, I was talking about this at the university with some friends. Supposedly, his doctors probed around with their bare hands and dirty instruments, trying to find the bullet.”
Caro said quietly, “It’s as if none of them had ever heard of Lister and the need for sterile instruments. The poor president died of acute sepsis.”
“They were all fools and should have known better,” Mitchell said. “San Francisco had its own case of possible death by physician back in the 1850s. In this case, it was the shooting of James King, a prominent newspaper editor, by a local corrupt politician named Casey. At the time, it caused a major uproar in the medical community. The story I heard was that the poor man lay dying, with a gaping wound in his chest, as local doctors fought over who was going to treat him.”
Mitchell turned to Caro and said, “Miss Sutton, you might be especially interested in this part of the story. The main rivals over who was going to treat the wounded man were William Toland, who founded our medical school, and Beverly Cole, who is now our dean. By the end of that day, they had become bitter enemies. Toland was probably the most highly respected doctor in town at that time, while Cole was only in his early twenties and just starting to make a name for himself. Toland won the struggle, and he was the one who stuck his hands into the wound to get the bullet. He also recommended that they stick a surgical sponge into the wound to stop the flow of blood.”
Nate interrupted at that point. “You know, I read about that case when I was studying for the California Bar. Five days after this happened, King died. This Dr. Cole believed the cause of the death was the insertion of the sponge, which caused a massive infection. If I remember correctly, he was a good friend of King, and he went around saying King’s death was caused by malpractice. The coroner’s jury sided with Toland.”
Mitchell said, “What I heard was Cole couldn’t let it drop. It’s rumored that this was one of the reasons he helped found a medical school in competition with Toland’s school. That school was the origin of the school that eventually became the Medical College of the Pacific, where Dr. Blair got her degree.”
Annie exclaimed, “You’re saying he helped start a rival institution because of this feud with Dr. Toland?”
Mitchell said, “Not only that, but when it came time to replace the old City and County Hospital, which was conveniently located next door to Toland’s school, Cole is the one who persuaded the city fathers to build the new hospital way down south of market on Potrero. And I must say this has been a nuisance for all us medical students who are in the University of California’s medical school. And, of course, it is no coincidence that the new hospital was built just a few blocks east of the Medical College of the Pacific.”
Annie said, “I believe that Dr. Granger, the doctor who recommended that Mrs. Truscott turn to the dispensary for treatment, is a professor at the Medical College of the Pacific.”
“Yes, he is, as is his son.” Mitchell leaned back and took a sip of coffee.
Caro Sutton said, “I’m confused. How is it that Dr. Cole is now our dean if he helped found the Medical College of the Pacific?”
“Oh, the rival medical school went moribund for a few years, and Cole’s an ambitious man,” Mitchell replied. “He believed that if he wanted to have a chance to influence the next generation of doctors in the city, he needed to be part of the new California University’s medical school. So Cole changed allegiances, much to the consternation of doctors like Granger.”
Annie asked, “Is there still some ill-will felt between these two medical schools?”
“Very definitely, Mrs. Dawson. Just recently, Dr. Granger and Dr. Lane, the current head of the Medical College of the Pacific, got quite upset when Dr. Cole negotiated a contract with the City and County Hospital to give our medical department control over which medical staff the hospital will hire and which medical school graduates will get the coveted yearly internships.”
Laura said, “So, is that why you made that little face when Annie brought up Dr. Blair? Because she was a graduate of your rival school?”
Mitchell’s laugh held a tinge of bitterness. “Oh, yes, Laura, let’s just put my opinions about Dr. Ella Blair down to professional rivalry and old school spirit. She, at least, got a residency. I’ve had to make do with working three jobs while I save up enough money to start my own practice.”
Annie wanted to get back to the point, so she said, “What I want to know, Mitchell, is do you think the reason the Truscotts have turned against Dr. Granger and the dispensary could have any connection to this old rivalry? Say, for instance, if Mr. Truscott asked someone associated with your
medical school, say one of your professors, for their opinion on whether or not Mrs. Truscott should have had her surgery?”
Mitchell turned more serious. “It’s possible.”
Annie nodded. “That helps explain why Dr. Granger told me and Dr. Blair that the letter from Richard Truscott could be the result of someone actively trying to ruin the reputation of Dr. Brown and himself. He was particularly upset to discover that Phoebe Truscott was now under the care of a Dr. Skerry.”
Mitchell, who had been starting to take another sip of his coffee, put the cup down with a bang. He said, “Dr. Imogen Skerry? My stars! No wonder Granger’s worried. Talk about bitter rivals. Dr. Skerry hates both Harry Granger and Dr. Brown. Skerry has her own local medical journal, which she uses to malign those people she doesn’t like. Even worse, if Mrs. Truscott really has developed peritonitis, and Dr. Skerry is the one treating her, there’s a good chance the poor woman could die.”
Chapter 15
Annie sat in the rocking chair in her bedroom, nursing Abigail, while Laura and Caro sat at the round table and discussed the evening’s events. Nate and Mitchell had stayed downstairs in the dining room, arguing over some local political scandal. Nate tended to support the Republicans; Mitchell, as a good Irishman, was a Democrat.
She said, “That was certainly a very interesting evening. I am so glad you were able to come, Miss Sutton.”
“I appreciate having been invited. I confess, after hearing about the Truscotts, I am interested in learning more about the Pacific Dispensary, particularly their decision to have the entire permanent staff be female.”
“I am sure I could arrange for Dr. Blair to give you a tour,” Annie said.
“I’m glad you found the discussion interesting, Caro. However, what I really want to know is what do you think of Mitchell? I know you said that he showed up as the laboratory assistant in one of your clinical classes, but now that you’ve spent some time with him, what’s your overall impression?”
“A bit too full of himself for my taste,” Caro said. “Although, from my experience so far, this is almost a prerequisite attitude for young men in the medical profession.”
Annie said, “I don’t remember him being quite that way the couple of times he’s been to the boardinghouse. Maybe medical school has been a bad influence on him. I thought if he called me Mrs. Dawson one more time, I was going to hit him on the head. Made me feel ancient, even though I know for a fact that I am at least three years younger than him.”
Laura laughed. “In my case, I’ve always thought he treats me like some sort of child…although that could be my brother’s bad influence on him. This evening I realized I hadn’t seen him since Abigail was born, and I hadn’t seen him much before that. He sort of disappeared once we all started up at the university.”
She turned to Caro and said, “The summer before last, when Kitty Blaine and Seth would come here to study on the weekends for the university entrance exams, he would stop by…say he was checking on whether Seth was ready to go back to the boardinghouse with him. But we all knew he was here to see Kitty. The four of us did some things together. A trip to Woodward’s Gardens once. And remember, Annie, when we went into the mountains to get the Christmas tree that year? I think he asked her to dinner once. She turned him down.”
Caro said, “I do have difficulty imagining the two of them together. Dr. Mitchell doesn’t have enough polish for our Miss Blaine.”
Laura laughed. “I remember she was surprised that he thought her father would let her go to dinner with a man, unchaperoned. And that was that. He stopped coming by. Of course, now that I think about what did happen to her, I can’t help but think she would’ve been a lot safer with Mitchell. He might be rough around the edges, but I do believe he has a good heart. And it’s a shame, given how hard he worked to get his medical degree, he isn’t really able to start his career yet.”
Annie said, “I agree, and now I feel bad about being so irritated with him tonight. Nate once told me Mitchell came from a poor Irish family back east, worked his way to San Francisco so he could apprentice himself to an uncle with a pharmacy. Like your Seth, Laura, he had little formal schooling before he started medical school. No wonder he lacks polish. And I guess I didn’t think about the fact that it would take capital to start out as a doctor, either that or get brought into someone else’s practice.”
Laura said, “And he was so good to Nate during your confinement. Every time I would come down to give a report, there he’d be, telling Nate that everything was going according to plan, that he had nothing to worry about.”
Caro said dryly, “That confident manner, even when it might not be warranted, is what a patient wants from a doctor. My difficulty with it is that I’ve personally seen the damage that can be done when a patient blindly believes that a doctor knows exactly what needs to be done.”
Annie said, “Well, that brings us back to what he said about Dr. Skerry. Tilly came to the door at that point, and I missed a bit. Did I understand him to say there was some sort of feud between this Dr. Skerry and Dr. Granger and Dr. Brown?”
Laura said, “He said there was actually a newspaper article about it, so I thought I would try to track that down. Something about an attempt by Dr. Skerry to get accepted by the California Medical Society. He said she was turned down…and it was Dr. Granger and Dr. Brown who said she shouldn’t be accepted, evidently because she was a homeopathic doctor.”
Caro said, “Well, if that’s true, then she shouldn’t have tried to get accepted by that society. There is a different state society just for homeopathic practitioners in California. They would be the best organization to judge her training and experience. I suppose she might have wanted to be recognized by both. That would be odd.”
Laura said, “Annie, did you hear Mitchell say Dr. Skerry has her own newspaper? He says he reads it occasionally for a laugh it is so outrageous. But he remembers Skerry said some very cutting things about both Dr. Brown and Dr. Granger in one article. There was something about Skerry wanting to be a smallpox inspector and that Granger had blocked that as well. I thought I would track down this paper she puts out, see which printers produce it. Maybe I can find back copies and see what all the fuss was about.”
“Thank you, Laura. That would be a help. And I can certainly understand if this Dr. Skerry felt her professional bona fides were not being respected, she might have a reason to try and turn the Truscotts against the dispensary. But that doesn’t explain why Mitchell feels that she could be dangerous. I thought the whole argument for homeopaths was that the medicines they prescribe can’t harm you.”
“That’s generally true,” Caro said. “The theory, at least as posited by the German doctor that started it all, was ‘like cures like.’ Homeopaths believe if you take very diluted amounts of the organisms that cause an illness or cause the symptoms of an illness, this will somehow cure that illness. There is some disagreement over whether there is actually anything left of the original matter at the end of this dilution process. But the assumption is that, if there is, it would be in such a minuscule amount that it couldn’t do any harm.”
“So how is that supposed to cure the disease?” Laura said.
“That’s a good question, and of course there doesn’t seem to be any scientific basis for this theory.”
“But you mentioned that homeopathic doctors have their own medical society, their own schools, so doesn’t that make them real doctors?”
“That is also up for debate,” Caro said. “Most physicians who have been trained at institutions that reject the theory behind homeopathy think their practitioners shouldn’t be recognized as doctors. One problem, however, is that there are a lot of unknowns associated with regular medicine as well. In fact, a lot of people have turned to homeopathy or alternatives like the water cure because these methods are much less likely to harm a patient. As a result, it is hard for regular doctors to argue that they should be the only ones to practice medicine. In addition, this
is a hard stance for statewide politicians to take when there are a lot of good citizens, who vote, who believe in homeopathy.”
Laura said, “Does this mean that just anyone can say they are a doctor and get listed in Langley’s directory?”
Annie laughed, startling Abigail, who stopped nursing for a moment and frowned. She patted her daughter on the back and said, “You can pretty much call yourself anything you want…when advertising in the newspapers or in the city directory. I learned that when I started looking into what I could do to advertise myself as Madam Sibyl. A good number of so-called clairvoyants announce in their ads that they give medical advice, and I had clients who wanted me to do that for them. So I wouldn’t be surprised if even some clairvoyants have gotten themselves listed in the directory as physicians.”
Annie looked over at Caro and saw by the lack of surprise on the young woman’s face that Laura had told Caro about her years as Madam Sibyl.
Caro took off her spectacles, polished them with a handkerchief, and put the glasses back on. Then she said, “It seems to me that the issue isn’t whether Dr. Skerry is doing something illegal. California says that if someone like Dr. Skerry got a medical degree from an institution that the California Homeopathic Medical Society accepts as legitimate, she is a doctor and can practice medicine in the state.”
Annie said, “Then what is the problem?”
“The difficulty is that while homeopathic medicine by itself shouldn’t harm a patient, neither is there scientific evidence that it will do anything to cure them. This wouldn’t be a problem, for example, if a homeopathic doctor treated a patient who had a bad cold or had eaten something that disagreed with them. But if the patient has a serious illness that could be cured using modern scientific methods, then…”
Lethal Remedies Page 10
