Die Once Live Twice (24 page)

“The whole state of Iowa is one big Central Park,” Marion quipped.

Supper was an Iowa banquet: garden salad, corn-fed beef, fresh sweet corn and strawberry-rhubarb pie. As Steindler forked a bite of the salad, he asked Jeffrey how Iowa measured up in his review.

“Today I saw a clinical program with students receiving education by scientific teaching. Congratulations.”

“Will we be approved?”

“Most certainly. You are now a leader in the Midwest.”

Jonathan was asking Louise about Iowa. “This is a state of transplanted Germans and Czechs,” she said. “Of course, Germans are not as civilized as Austrians,” and her eyes smiled, “but at least they don’t have such bad food as you English!”

“I’m Irish,” Jonathan said defensively.

“Even worse,” Louise grinned. “Iowa is peaceful, unpretentious. No grand architecture or art. But they are good people and we experience no anti-semitism.” Helene Specht, a handsome thin Austrian woman with dark brown hair tightly woven into a bun, stood to clear the salad plates. Her brown eyes sparkled in a bony face softened by full lips. “Social life is farmers gathering Saturday night at a bar or the barbershop to talk gossip,” Louise continued. “The next morning they are back in town for church. The social outing of the month is when all the wives bring food and have a potluck dinner after church.”

“They don’t have to gather more often than once a week to know all the news. The women just listen to the phone whenever it rings because everyone has a party line and no conversation is private,” Marion said.

“Sounds just like my life in New York,” Jonathan joked.

As the laughter subsided, Louise and Helene served plates of steak and sweet corn. Between bites of steak, Arthur asked Jonathan about research at the Rockefeller Institute. “Medical progress seems to work in fits and starts, Arthur. The first decade was one discovery after another, but there aren’t any revolutionary changes in the pipeline. We’re working to find a chemical from a microorganism that will kill bacteria. We can’t even study viruses until we can prevent bacteria from overgrowing them. So we’re in a bit of a stalemate with the germs!”

“Medical breakthroughs are more dependent on a brilliant man solving a mystery than they are on just hard work. And each generation has very few brilliant men. In Europe, for instance, change was caused by Pasteur and his protégés.”

Jonathan thought about what Arthur had said. It was true that what had been accomplished in the past twenty years was a consequence of the vision of William Welch. The leaders in America had been trained by him. Flexner at Rockefeller Institute for research, Osler for clinical medicine and Halsted for surgery. To effect change one person transcended all others, transcended the events and lead the revolutionary change.

“The great figures have different minds from the rest of us,” Arthur said. “They originate ideas, crystallize complex dilemmas into a brilliant solution and have the charisma to convince men to accomplish their vision. Those who follow the leaders have minds that can absorb the visionary idea and extend it, maybe even improve it, but they excel more by work ethic than by originality.”

Frederick Specht, finishing his steak, interrupted and said their work with TB was causing a revolution in thinking in Iowa. Would Jonathan lecture to the residents the next morning and explain the public health program in New York? “It is hard to make such changes here. On the farms they drink water out of their wells and drink raw milk, which is why we have so much bone TB.” When Jonathan agreed to do so, Frederick told him he would send a resident to the hotel to accompany him to the lecture hall. “I will miss your speech because—guess what—I am operating a TB spine. I am doing a Hibbs fusion.”

“Hibbs? That’s our friend’s colleague,” Marion gushed. “Russell Hibbs is at the Hospital for the Ruptured and Crippled and works with Phil Spanezzi.”

“Yes, we visited Doctor Spanezzi three years ago when we came to the United States,” Frederick responded.

“Why
are
you in Iowa?” Marion asked.

“The short answer is, three years ago I came to New York from Vienna to study for six months. I met Phillip at Ruptured and Crippled. Helene became comfortable in this country and wanted to stay here. I knew Doctor Steindler from Vienna,” he said, nodding at their host. Steindler didn’t look up from the strawberry-rhubarb pie he was inhaling. “He was at Drake University and convinced me to go to the University of Iowa. Well, we thought all of the United States would be like New York City. Ha! Iowa City is a village.” He took his wire-rimmed spectacles off and cleaned them with a handkerchief.

“I want to see your operation tomorrow, Doctor Specht,” Marion said.

“Sure. If you don’t want to hear your husband speak.”

“I hear him speak every day!” she teased.

“Please, Frederick. Please take her to surgery,” Jonathan begged.

“Marion, you’re more than welcome to join me.”

With dessert finished, Helene stood and said, “Come on, Arthur. Let’s play together.” They all moved to the living room and Arthur sat on the piano stool. The soft chords of a Mozart piano concerto filled the room, and when Helene joined him on the violin, the Sullivans were awed. Within moments, Steindler and Helene had transfixed their audience. Frederick whispered to the three Sullivans that Arthur and Helene had been music students together in Vienna as youngsters.

Jonathan leaned over to Marion. “Maybe New York City doesn’t have everything that’s great after all!”

Chapter Twenty-four

F
rederick Specht was dressed in white operating room pants and shirt. Over his mouth and nose he wore a new addition, a fine mesh gauze mask four layers thick. He scrubbed his arms and hands with phenol to remove his skin germs. One assisting resident and Marion Sullivan washed up with Specht as he described tuberculosis to them. “TB of the spine is as old as man. Hippocrates described it. In ancient India it was called Yakshma. It is an opportunistic germ that preys on susceptible people. This boy has a fifty percent chance we can stop his disease and he will be healthy. There is a twenty percent chance he will die even with surgery. The rest of the children survive, but just really don’t become healthy again. We can save this boy. He has a good constitution.”

The patient was positioned on the table face down with his hips flexed so his back was relaxed. Sterile drapes isolated the area on the back to be operated on. Chloroform anesthesia was administered through the use of a new device, the endotracheal tube. It prevented spasm of the vocal cords, which could be a lethal complication, and allowed a more predictable and safer dose of the anesthesia drug to reach the lungs.

Every step of the operation was designed to avoid infection. The boy’s skin was scrubbed with carbolic acid over a wide area several hours before the operation. On the operating table, his back was painted with a solution of iodine. Only sterile instruments were used in the wound and the nurse passed instruments with a forceps to avoid touching them. After Frederick made an incision in the midline of the back, towels were clipped to the wound edges to cover the skin and fat and act as a barrier protecting the raw tissue.

First, the ligamentous tissue that connected the spinous processes, the bony prominences in the crease of the back, was exposed. Working efficiently and swiftly during the exposure of the spine, Specht split the ligament that connected these bony phalanges. Marion watched every move of the knife. “We are operating only in the posterior spine,” Frederick pointed out to Marion. “The infection is anterior in the vertebral bone, deep in the body. We will not go there. Operating in that infected area spreads the disease, causes chronic drainage, and could infect the fusion I am creating.”

Specht peeled the spinal muscle away from the spinous processes and placed retractors to keep the muscle out of the operating field. Now the operation became more intense. Specht knew he must be very meticulous peeling the periosteum, the tissue with the cells that make bone, from the vertebrae. This was the tissue that would create the bony fusion that made success possible. If this was frayed no fusion could happen because no new bone would grow. The periosteum needed to be intact so it could be folded back over the bone when the preparation of the fusion mass was complete. As he operated, Frederick marveled out loud to Marion at the healing power of the human body. “We can cut it, break its bones, put drugs in it, infect it, kill tissue, and the body will recover. It is such a mysterious machine. I wonder if we will ever know how its cells work.” Marion nodded her head in knowing agreement.

Specht cut across the base of the spinous processes where they attached to the vertebrae with an osteotome, a sharp tool that could cut bone. This freed the phalanges of bone, which became struts he would use as grafts between the vertebrae. He roughened the back of the vertebral bone with the osteotome until it bled. Now he was working quickly. Too much blood loss meant death. There was no way to replace blood. He laid the freed processes across the vertebrae to bridge them. Finally, he folded the periosteum he had so meticulously preserved and sutured it over the bone prepared for fusion. “I pray it has active cells, which will build the fusion bridge even bigger and stronger,” he told Marion.

Specht stepped back and peeled off his gloves. “Close the fat and skin layers and when you are finished call me,” he said to the resident. “We will apply the plaster cast together.” Frederick explained to Marion that the cast must be worn for three to six months while the bones grew together. The boy would remain in the hospital for three months so Frederick could keep watch over him in his cast. Marion moved away from the operating table and the circulating nurse helped her remove her gloves and gown.

Marion watched the cast applied. Strips of gauze were dipped in the plaster and applied over a cloth laid next to the skin. The cast was molded to the boy’s body from the armpits to the knees but an opening left in the crotch for bodily functions. “When he is awakened we will hang him upright so the cast will dry without cracking.”

What Frederick Specht would never know was that this operation would have so much success creating fusion of the spine that it would be the operation performed for spine fusion for the next seventy years.

Chapter Twenty-five

“D
octor Park is on the phone,” Marion yelled at Jonathan, who was enjoying his brandy and cigar on a late June evening in 1916.

Jonathan quickly removed his cigar from his mouth and set it in the ashtray. “Hello, Bill.” Park told him that the Health Department had confirmed an epidemic outbreak of infantile paralysis in Pigtown and instituted a quarantine of that Italian immigrant neighborhood in Brooklyn. But local gangs such as the Italian Black Hand were resisting these measures. The priests were flooded with pleas from parents, frantic because their children were paralyzed. Could Jonathan and Marion set up a clinic to treat the residents of Pigtown? Jonathan agreed to meet him at the Health Department office, and after talking to Herman Biggs there, they would go to Pigtown.

“What an awful name for a community,” Marion frowned. “What are we to do? There is no vaccine, no way to change the water or milk on short notice. There is simply no way to change the course of this epidemic. I hate to say no, but I’m more worried about this spreading to our Ward. I am already seeing kids with muscle aches and no appetite. I need to be there for our own people.”

“I have to go. It may provide a way to study this polio virus.”

“Well, you go then. But be careful.”

Jonathan was excited. If he could grow this powerful strain on tissue culture, he might be able to isolate it in his laboratory. Flexner’s research with virus grown in monkey nervous tissue was going nowhere, and besides, vaccine from animal nervous tissue caused brain inflammation in humans. Jonathan had become a believer in Marion’s research on her patients. This virus did not come through the nose. Moreover, Karl Landsteiner, in Vienna, had fed ground-up nervous tissue from a polio victim to two monkeys and both of them became infected with infantile paralysis. That proved that this virus could enter through the stomach. Jonathan would obtain some infected tissue from one of the children who died in this epidemic and culture it with stomach and kidney tissue. If he could get it to grow in this tissue he could develop a safe vaccine.

Biggs was humbled when Jonathan talked to him at the Health Department offices. Biggs had told the public as early as 1910 that the standard classes of infectious diseases were under control, that the main killers of mankind were now heart disease and cancer. His prediction hadn’t come to pass. TB remained the number one cause of death, and pneumonia second. Cancer was a distant eighth. When Biggs asked Jonathan to go into Pigtown and evaluate the epidemic, Jonathan agreed to do so, but in return he wanted some tissue from a Health Department autopsy to use for tissue cultures. Biggs readily agreed.

As Jonathan and Park walked together into Pigtown, angry men stared at them from every corner. “
Deja vu
of twenty years ago,” Jonathan said.

“It is like yesterday to me except that then it was wintertime,” Park answered. “Angelo is our gift from that trip into that hostile neighborhood.”

As they came to the Department of Health clinic, Jonathan shuddered. Written in blood on the wall were the words, “If you report our babies or our homes we will kill you.” As he was reading this threat a hand grabbed his shoulder and Jonathan jumped five feet in the air. Turning and simultaneously crouching, he looked up at the face of a young Italian. “Relax, Dottore, it’s me, Angelo!”

“You’ve never looked so good, Angelo!”

Angelo said Marion told him Jonathan and Park had gone to Pigtown. “I told her that this was a dangerous place, lots of dangerous men here. So she called a cab and sent me to be with you. The Black Hands are my friends. Now that I graduated from NYU Law, I am now one of their lawyers.”