Die Once Live Twice (30 page)

The two of them stopped talking as the whistle of the four o’clock train pierced the air. Frederick stood up. “Jonathan, you asked about seeing the hip nail. Come back to the hospital with me. I have a patient arriving on this train who has a problem with his hip. Jimmy, let me tell you something about the hip nail. It was invented by Marius Smith-Petersen, who had the idea while riding home on a train from a medical conference in 1925. It took him more than five years to finalize it. So you see your investments will have to be for the long term, not the quick buck.”

In Frederick’s office, he pulled a three-inch long triflange nail from his desk drawer that would be used to secure the two fragments of a hip fracture and hold the bones aligned and stable while the bone cells grow together across the break. Jonathan said, “It seems so simple, Frederick. Why didn’t someone design this years ago?”

Frederick shrugged. “The key is the shape. Before, only round nails and smooth nails were used. You know, a round peg in a round hole. But it quickly worked loose. This design stays in place.” Fixation of the fracture meant patients could get out of bed, which in turn meant that a hip fracture was no longer sure death from pneumonia, urinary infections, bedsores, or blood clots caused by bed rest.

“The other deterrent has always been infection. Not only do we open the body to the bone, but we put a metal device into the bone. The device can have bacteria on it and the blood supply to the bone is disrupted by the fracture so healing is compromised and germs have an environment in which they can flourish. All we can do to guard against that is to be scrupulously clean and keep the surgical environment perfectly sterile.”

“No wonder Uncle Jonathan is always desperately looking for a chemotherapeutic drug to kill germs,” Jimmy frowned. “What a day that will be for medicine!”

Frederick agreed to work with Jimmy in building the Sullivan Company’s medical business. He knew as well as Jimmy that devices were the future of orthopedics. Jonathan recognized this advance to be just as important as a new drug. These devices influenced cell action too. If bone-forming cells, osteoblasts, were subjected to constant motion they quit working. Then fibroblasts took over and formed fibrous tissue, and that prevented the bone from healing. Patients couldn’t walk on bones linked by soft tissue, but bone cells that were stable formed new bone.

Frederick brought Jonathan along to meet his new patient. Wesley Johnson was a farmer, short, stocky, and sturdy. Now he was completely incapacitated and without the hip nail operation was destined to die. Frederick shook his hand and introduced him to Jonathan. “Doctor Sullivan is a colleague of mine who would like to observe the operation. So, let me ask you, Wesley, what exactly happened?”

Johnson sighed heavily. “I was fixing a few holes on the house roof like I do every year after winter is over. The shingles broke free and that was all she wrote. I rolled off and hit the ground. I figured I was a goner.” Wesley shook his head. “Might as well be a goner if I can’t work my farm. I just hope you can fix me up good, doctor. Life’s hard enough already with the drought and the Depression.”

“I’ll get it done, Wesley,” Frederick said.

The next morning Jonathan stood next to Frederick as they scrubbed their hands and arms using sinks next to the operating room. Jimmy stood off to the side watching. There were two operating rooms at the north end of the orthopedic hospital, isolated from each other and each with its own fresh air supply. Everyone in the operating room wore a surgical scrub suit, a hat, and a mask. If the person was to be next to the operating table, a sterile gown and surgical gloves were added. Jonathan thought of how surgery was performed when he trained in the 1890s—in an open amphitheatre with multiple curving rows of seats ascending above a pit in which the surgeon operated on the patient. No one wore gloves or a mask or a hat to cover hair. A surgical apron was worn over the surgeon’s suit.
No wonder infection rates were prohibitive and elective surgery avoided,
he thought. Even with these modern improvements in the operating room environment, infection rates could still be ten to fifty percent depending on the surgery.

Wesley Johnson was lying supine on the operating table with sterile drapes covering his body except for the left hip area. Frederick made a longitudinal incision down the front of the hip from the prominent bone at the top of the pelvis down into the groin. Beneath the skin and fat, Jonathan and an assistant separated two muscles with retractors. Frederick incised the capsule that enclosed the hip and suddenly blood spurted out. “Blood from the fracture,” he explained. Using bone forceps he aligned the two fractured fragments of the hip bone. “Hold these, Jonathan.”

Jimmy was standing on tiptoes against the wall trying to follow Specht’s moves. He knew Jonathan’s colleague Spanezzi was working to modify this part of the operation, not opening the hip but rather manipulating the leg as a way of reducing the fracture and then confirming it was aligned by x-ray. It was inevitable that the operation would be modified, as every treatment was as doctors used it.

Frederick made a stab incision on the side of the hip and the scrub nurse handed him the flanged nail. He punctured the outside of the femur bone with the sharp tip of the nail and then began to hammer it slowly into the bone. Tap, tap, tap. With his gloved hand he felt the fracture site to be sure it did not separate as the nail was malletted. Tap, tap, tap again. “I’ve crossed the fracture,” he announced. Ten more blows and the nail was secured in the bone.

Frederick cradled the leg in his hands and moved it in a circular fashion, then bent it and straightened it. Jonathan watched the hip bone move as a unit. “Amazing. Solid as a rock.”

“Yes, he’ll be out of bed and walking on crutches within five days. There is more than one way to battle the Captain of Death. And his sergeant, Bed Sores.” Jonathan and Frederick shared a laugh. Jimmy, against the wall, thought excitedly of the number of these hip nails he could sell.

Jonathan, Jimmy and Frederick sat in the doctor’s lounge after the operation. “It really is exciting when we get a new truly effective treatment for patients,” Frederick said. “We can do so much more than we could thirty years ago when I first treated patients. We have tamed so much of the biologic chaos Nature causes, even without a miracle drug.” Frederick looked at his hands, his fingers pressed together to form a steeple. “There are men like Welch and his protégés who are great research scientists. They are driven by their scientific prowess and the seduction of unraveling the mystery of the human body, always trying to grasp something one step beyond their current reach.”

“That sounds like you, Uncle Jonathan!” Jimmy said. Jonathan nodded in affirmation.

“And then there are physicians like me. My calling requires more of a human touch. Without patients there is a void in me no laboratory or great discovery can ever fill. The joys and suffering of my patients will always be mine to bear because I connect with those I treat. Medicine’s improvements have enriched my life because I can better relieve the suffering of my patients.”

Chapter Thirty

—1936—

T
he scraping metal sounds of the stool sliding down towards her legs sent a shiver up Marion’s spine. She closed her eyes tightly as her feet were gently lifted into the icy steel stirrups and the blanket rolled back off her legs. One of the nurses moved the lamps closer to her lower limbs and a second nurse positioned herself next to the doctor to assist him. The squeak of soft rubber could be heard over the nurses’ voices as Phil donned his gloves.

Marion had come to see Phil, now respected as one of the original general surgeons in New York City, because she knew something was wrong. The cramping in her abdomen had finally subsided but she could still feel the sticky sensation of drying blood between her legs. She knew enough about miscarriages to recognize the symptoms.

“Are you pregnant?” Phil asked.

“Up until today, I didn’t have any reason to think so. I haven’t had any symptoms. I thought I was past all that anyway.” Although she and Jonathan still enjoyed each other, they had never even had a hint of a pregnancy since Jackson. Surely, if an accidental pregnancy was to occur it would have happened years earlier.

“No nausea, weight gain, breast tenderness?” His eyes never left hers.

“None. I’ve been tired lately.”

“Hmm...well, let’s take a look, shall we?”

The speculum was gently inserted into her vagina and she felt the blade begin to open. Marion grimaced at the intense and unexpected pressure. The warmth from the rush of blood flowing out of her vagina neutralized the chill of the metal blades. Marion felt Phil’s right hand reach inside her vagina and move side to side within the pelvic cavity and his left hand pushing and palpating through the skin over the pelvis. Marion couldn’t help but cry out in pain when Phil’s hands explored the right side of her pelvis.

As if producing pain was his goal, Phil quickly removed his hands, pulled off his gloves, and pushed away a lamp in one long movement. The nurses cleaned the blood from between her legs, removed her feet from the stirrups and replaced the sheet over her. The fresh thick cloth they placed between her legs felt good as Marion clamped her thighs together.

Phil washed his hands in the sink, struggling to find the words to tell Marion. He slowly walked over to her, took her hand and looked softly into her eyes. “You’re not pregnant, Marion.” Marion worried about the intensity of his furrowed brows. She knew Phil so well.

“If not...”

“I found a large mass in your pelvis. It concerns me that the surrounding tissues of your uterus are inflamed, and coupled with your fatigue I believe we need to investigate further.”

Marion sat up in disbelief, sudden fear now rushing through her veins. “What? I mean...what could it be? What are you suggesting?”

“We won’t know for sure until we take some tissue samples, but I suspect a tumor. I will arrange the surgery for this week, but you should get into the hospital right away. You need a transfusion.”

“Well, stick your arm out, Speezi, and I’ll take some of yours again. It has worked so well for twenty years!” Marion smiled feebly.

Phil smiled back at Marion, then asked, “Is Jonathan at his office?”

“No. He’s in Washington, D.C., meeting with President Roosevelt. He and Jimmy helped raise over a million dollars for infantile paralysis supporting Roosevelt’s Birthday Ball last month.”

“Well, that doesn’t surprise me. He’s a highly respected figure. I will call him at his hotel.”

“He’s at the Willard.”

“Good. Marion, the nurse will get you admitted to the hospital.”

When Jonathan received Phil’s phone call, he blanched and his breath came fast. Marion was anemic from blood loss and in the hospital for a transfusion. Phil was certain she had either uterine or ovarian cancer and would operate her later that week, when Jonathan was home. Did Jonathan know of any other options for ovarian cancer? Thoughts raced through Jonathan’s brain, but he said he would inquire among his colleagues at Rockefeller Institute. He knew Marion could die from this disease. What would he do if she did? The two of them had become one. “Phil, please tell Marion I am on my way to her.”

Jimmy flew Jonathan home and then went on to Boston to bring Jackson back from Harvard. Jonathan spent that night in the hospital with Marion, sleeping in the unoccupied bed in her double-occupancy room. She tried joking with him when he first arrived, but he felt hollowed out and Marion really didn’t feel very lighthearted. Mostly they just hugged and held hands.

With the morning’s light, Jonathan took the long walk to Rockefeller Institute, where he headed straight into the office of Peyton Rous, who had first begun experimenting on cancer vaccines and reproduced malignant tumors in chickens on the theory that the malignancy was viral. When he reported these findings, and proposed a virus as the cause of cancer, he faced a flood of criticism and mockery from his peers, but Jonathan thought Rous would know if there was any treatment for Marion’s cancer.

Rous was a workaholic and by the look of his stubbly beard and mussed hair, he had most likely been at the Institute for the past three or four days. His face became even paler when Jonathan told him of Marion’s cancer. He offered his friend coffee while they talked in his cramped, paper-festooned office. Finally Jonathan made the request that even he knew was almost certainly futile. “Peyton, is there anything you can do? Does your research suggest anything?”

Rous shook his head. “Jonathan, I’m not sure how much help I can be for this. There is not any successful work on the viral aspects of uterine or ovarian tumors. Much of what we think about those tumors falls into traditional speculation that malignant tumor cells develop spontaneously, not virally.”

“But what about Bill Coley’s work?” William Coley agreed with Rous that some cancers had viral properties and had been experimenting on that theory for about five years. Coley had observed that some patients had a massive reduction of their tumors when they contracted a bacterial infection. He had injected a mix of bacterial infections into patients with inoperable tumors and indeed some patients had responded to that treatment. “Please, I’m grasping at anything right now, Peyton. I’m in uncharted territory here. I can’t help but wonder, after all the work we’ve been doing these past years, why can’t we find a cure for this cancer?”