Die Once Live Twice (23 page)

Lucia, who had come to help, held the girl’s arm still with gloved hands while Jonathan unwrapped the glove from around the syringe and needle. Anna’s veins were collapsed because she was dehydrated, but he managed to find one distended vein in the crook of her arm. As Jonathan slid the needle into the vein, he felt a surge of encouragement because Anna’s blood was not black, a terminal sign of anthrax infection. Sitting on a chair at the bedside, leaning forward over Anna’s arm, he patiently advanced the plunger of the syringe. One minute, two minutes, five minutes, and it was done. He sat back, relieved she was still alive. He withdrew the syringe and needle from the vein. Lucia put pressure on the vein to allow it to clot.

All they could do now was wait. Jonathan sat in a bedside chair staring at Anna as if he could do something if she turned for the worse. Lucia put wet rags in Anna’s mouth so she would suck in water. A half hour passed and Anna was still alive. “I am certain now the injection did not kill her,” he told Marion. Her eyes widened as she realized what Jonathan had been facing.

Six hours passed with Anna still alive and her breathing no worse. It was now evening, but Jonathan and Marion were not going home. “I couldn’t eat,” Marion said to Jonathan. “I couldn’t sleep. My mind would be here every second. So why go home? I’m staying with you.” Rabbi Radulovic sat with Anna’s mother and prayed with her. At midnight Marion was keeping watch in the bedside chair and Jonathan had fallen asleep with his head on Marion’s desk in the back room. Lucia had gone home. Anna’s mother had not moved and still held Anna’s hand. The rabbi dozed next to her.

Jonathan was jarred awake by Marion’s hands on his shoulders. “What time is it?” he asked.

“Four a.m. Come with me,” Marion answered.

For Jonathan, joy was the excitement he felt with Angelo’s vaccination or when Marion agreed to marry him—and now what he felt when he looked at Anna. She was mumbling in Russian to her mother, who was giving her water from a glass. Anna’s chest was quiet as she breathed. “She survived,” Jonathan said, restraining himself from shouting it as he held Marion’s shoulders and looked into her smiling eyes.

Lucia and Audrey returned to the clinic at dawn and relieved them. With Audrey able to communicate with the mother and Anna, the rabbi went home, too. As they rode the cab back home, Marion snuggled next to Jonathan. “You are the next Pasteur.”

“Not yet, my love. I knew this pyocyanase killed anthrax so it wasn’t blind luck, but it was luck all the same. If Anna had any other infection I wouldn’t have tried it. And I can’t do anything for other infections. At least not yet. What I need is a chemical from a microorganism I know is not toxic to people and that works against multiple bacteria. But this revealed a huge secret of Nature, Marion. I know for sure that bacterial antagonism works inside the human body.”

Chapter Twenty-three

I
n the spring of 1914 Jonathan and Marion boarded a train for Iowa to visit her parents in Des Moines and Jonathan’s brother Jeffrey in Iowa City. They were ready for a vacation. Jonathan’s past three years in the laboratory had not been very productive. Though he was sure bacterial antagonism would be the source of the answer to antibiosis, he could not figure out how to design an experiment to prove it. Some toxins were unstable and he did not know how to stabilize the chemicals. He studied molds, but none gave a chemical that killed bacteria. Research with viruses was no more satisfying. It was just not possible to isolate them without bacterial overgrowth. The only vaccine against a virus was the one against smallpox, and it had not been discovered by isolating the virus. In fact, no one had seen a virus yet. Infantile paralysis was studied vigorously without any solution in sight.

All these research failures left Marion with no new treatments for patients in her clinic. Aspirin was the only drug she had to treat patients and Jonathan was happy to write prescriptions for it whenever needed. Although not a cure, it was a wonder drug and everyone hoped that the nonprescription form would be available soon. She passed it out all the time for children’s fevers and muscle aches and pains. For anything else, public health principles and existing inoculations were her only source of treatment. Her intuition in 1907 that trust and compassion helped patients get better had been proven over and over again, and was all she had for heart disease, diabetes, and the occasional cancer. Fortunately, tuberculosis patients could be sent to Phil Spanezzi for surgery. Fractures would heal with traction and casts, except hip fractures. These patients Marion had to watch die.

They disembarked at Iowa City’s small brick railroad station, whose narrow platform was one-fourth filled with Marion’s two enormous trunks. “We aren’t
moving
to Iowa,” Jonathan said with some exasperation.

“Oh, shush. They still think I’m a famous actress in Des Moines, so I will need to look the part. You can wear what you want. In New York you’re an important doctor, but in Iowa I’m the star!’

“Well, la-de-da!” Jonathan smiled. “I’ll go hire a carriage for the princess. Wait here, Your Highness.”

The clip-clop of horses’ hooves was all that was the same as New York City. “I’ll bet you’ve never seen anything like
this
before,” Marion teased.

“Well, there is one thing that seems familiar,” Jonathan said, looking at the bars that lined both sides of Clinton Street. “I wonder if these are the study halls for the students?” Jonathan cracked.

“Well, aren’t you the pompous one. Did you think Iowans only drank homemade corn whiskey?”

“The air smells more of blacksmith shops and horse dung than cornfields. My goodness, I must bite my tongue.” Jonathan pointed to a group of buildings located on a large rectangular grassy lawn. “What are those impressive buildings? Especially the one in the center with a gold dome.”

“That’s called the Pentacrest and the buildings are the classrooms. The one with the dome was the first capitol building of Iowa, before the capital moved to the big city of Des Moines.”

The carriage stopped at the Jefferson Hotel, where Jonathan had booked one of the two suites with a washroom and a toilet. As they entered the lobby, Jonathan whispered to Marion, “Do you think we have to worry about bedbugs? Do they change the sheets here?”

“Jonathan, you’re a horse’s ass. Just because it’s not the Plaza.”

“At least I’m in a great place to be a horse’s ass. I’m probably worth money to a farmer!”

As Jonathan and Marion settled in, Jeffrey was on the train from Chicago lost in thought about his assignment to review the University of Iowa Medical School, oblivious to the clickety-clack of the train wheels rolling along tracks bounded by cornfields. He was not sure how he’d be received. The Medical Education Council of the American Medical Association, of which Jeffrey was the Executive Director, provided the AMA an opportunity to seize some control over medical schools, and thereby doctors. The Council had been set up because of the woeful condition of medical education in the United States. Doctors owned the medical schools and made a profit on each student they admitted, so anyone with tuition money could get in. In most medical schools students never examined a patient nor performed an operation.

In the mid-1800s, schools had nine courses and to get a medical degree the student had only to pass five. Even when Jonathan attended Harvard in the early 1890s, the course of study was only two years. Thanks to William Welch, Johns Hopkins Medical School had changed all that. Medical students needed a college degree, attended for four years, learned laboratory medicine, and were taught clinical medicine with an emphasis on patient contact. Welch, Katherine’s great soul mate, pressured the AMA to force bad medical schools to close or to be restructured and placed Jeffrey in its hierarchy. The AMA adopted Welch’s program as the only acceptable model of education, and in 1909, in partnership with the Carnegie Foundation, it established a review of all 160 medical schools. Abraham Flexner, Simon’s brother, was hired to do these evaluations and he recommended closing all but thirty schools, but offered a chance for survival to fifty others. By 1914 there were only ninety-five medical schools in the United States.

Jeffrey hoped for the best from the Iowa school. The clinical teaching there had been so inadequate that Flexner’s original report recommended Iowa become a two-year school offering only lectures and basic science. But the leaders in Iowa wanted a qualified medical school of full-time academicians and hired Arthur Steindler to be Chair of Orthopedics after his former school, Drake, had been closed by Flexner. With Steindler they brought in a new Chair of Surgery and of Internal Medicine. Flexner was impressed with these changes, and if Jeffrey’s report from this trip was favorable, Flexner would recommend Iowa for a Rockefeller grant to build a new university hospital.

When Jeffrey arrived at the same small brick railroad station where his brother had disembarked a couple of hours earlier, Doctor Frederick Specht stood waiting for him. As Specht tipped his hat, Jeffrey noticed he was balding rather rapidly. The two shook hands warmly. Specht was an Associate Professor of Orthopedics and Jeffrey’s contact person for his review of the medical school. “Frederick, I have a surprise for you.”

“You have certified our school?” Frederick straightened up to his full height of five-foot six-inches in anticipation.

“No. Not yet. Not until after this trip. The surprise is that my brother Jonathan and his wife Marion are meeting me here. In fact, they should be at the Jefferson Hotel now.”

“Mein gott! Your famous brother from the Rockefeller Institute?”

“The very same.”

“Oh, I must call Louise Steindler and tell her two more for supper. My wife is already there.” In his excitement Frederick left Jeffrey standing with his bag and quickly stepped to the station master to use the telephone. After making the arrangements, he helped Jeffrey carry his bag to the tiny parking lot where there were three horse-drawn buggies and one new Model-T Ford, to which Frederick pointed with pride. “Doctor Steindler’s.” Climbing into the driver’s seat, he donned driving gloves and sat rigidly behind the wheel. Traveling faster than five miles per hour risked blowing a tire in the rutted roads, so as they drove through the three-block-long center of town, Jeffrey could memorize the name of every business along the road. In front of small shops, owners swept their doorsteps, scrubbed windows, and chatted with passersby. A barbershop, two Sidwell ice cream parlors, six bars, and a drug store were identical structures differentiated only by their business signs.

Frederick turned right at what he called the “bookstore corner.” Students in their suits and hats were going in and out of the bookstore. As the Model-T passed Weber’s blacksmith shop the clanging of metal on metal drowned out conversation. Frederick pointed out the anatomy laboratory on the left and the university hospital in the middle of the block. After parking, they walked one block to a three-story building fifty feet long and twenty feet wide, with seven dormers on the top floor.

“This is where my TB patients are hospitalized,” Frederick said proudly. “I am the TB expert in Iowa and I will not be short of patients. Farmers rule the state government and they don’t want the expense of certifying their cows or pasteurizing the milk.” Unpasteurized milk was known to be the source of tuberculosis that infected the skeleton, most commonly the hip and the spine.

Jeffrey nodded sadly. “I understand. Last year New York State required pasteurization and it is the only state legislature to do so. Herman Biggs and Nathan Straus forced that.” Nathan Straus, the owner of a large department store, had lost his baby son to infected milk, so he financed and delivered clean milk to milk stations in New York City.

Frederick led Jeffrey on a tour of the infection hospital. Students, wearing smocks over their suits, were examining patients’ wounds with gloved hands. “Each student is assigned his own patients and is responsible for their care. If one of the patients goes to surgery, the student scrubs to help with the operation.” Frederick jutted his jaw as he stood with his hands on his hips. “There are teaching sessions daily and the students better know the treatment plans for their patients or they work overtime until they do.”

In the operating rooms of the main hospital, students supervised by full-time staff surgeons were operating. In the anatomy laboratory, students were learning every structure of the body by dissection. It was the last stop on the tour. Jeffrey expressed his admiration for the teaching program. “How far you have come in four years. Now you are a model for others.”

“The Johns Hopkins of the Midwest?” Frederick pleaded.

“Don’t let Doctor Welch hear you say that. For him, there is only one flagship! But I can tell you he would be prouder than he would let on.”

Specht beamed. “Let’s celebrate, Jeffrey. With our work done we’ll gather your brother and his wife and proceed to the Steindler home.”

When they all gathered at Steindler’s house, sherry was served in the front room with its bay window that faced the Iowa River down a steep rise. Jonathan said to Marion, “This reminds me of looking out over Central Park.”