Wedded to War (9 page)

The silence in the air sizzled with tension. Deep concern was etched on every face.

“The army currently has twenty-eight surgeons to care for seventy-five thousand volunteers.” Dr. Blackwell let the numbers sink in before continuing. “Twenty-eight. We must do our part, not just to prove what
women can do, but because if we don’t support the medical department, the Union army will simply not survive. Right now, men are dying when they could be cured with some very basic care and better hygiene. They are dying. As if the wounds of war were not enough, our soldiers are creating their own disease with their lack of personal hygiene and their filthy camps. And it will kill them. Dr. Bellows says that by their recent investigations, one half of the men already recruited will be dead of camp diseases by November 1. I’m sorry to lay this pressure on your shoulders, ladies, but I only do so because I know you can make a difference. You are not ‘silly women.’ You are brave. Or perhaps foolish, like me.”

Dr. Blackwell smiled ruefully at her captivated, confused audience. “Many of you have come to me privately to tell me how eager you are to follow in my footsteps. I might as well tell you publicly, however, that my footsteps have not followed a straight path to get where I am today.” She paused. “You’ve heard the story, haven’t you? About how I was finally accepted into Geneva Medical College?”

Charlotte felt her face grow warm. She was ashamed of the rumor, embarrassed to be brought face-to-face with it in front of the legendary Dr. Blackwell.

“It was a joke. The admissions office wasn’t quite sure what to do with a woman’s application, so they put the question to the student body. The student body was convinced it was a practical joke—who had ever heard of a woman doctor, after all?—so they played along and voted me in. That’s all true. You see, I didn’t come to be a doctor based just on my skills and credentials. And if I had such trouble getting started, I’m afraid you’ll have much trouble being accepted in your positions, as well.” The women shifted their weight as Dr. Blackwell spoke.

“I endured prejudice from my classmates and instructors. After I graduated, I was banned from practicing at most hospitals, so I went to France and trained at La Maternité and at St. Bartholomew’s Hospital in London. Only after that did I come back and establish the infirmary here, with my sister Emily and Dr. Marie Zakrewska. But here is what
you have working in your favor: like it or not, they need you. They need more people to help stem the tide of casualties, and if you are capable, your gender will not matter. In time, they must see that. You will succeed.” She nodded, punctuating her words with conviction. “You must succeed.”

Dr. Blackwell stepped back now, and Charlotte felt the color drain from her face as the attending physician took over with orientation for their training.
If Dr. Blackwell had to fight so hard to be a doctor, how can I hope to be accepted as a nurse?

With Dr. Blackwell’s words still ringing in her ears, Charlotte was paired with Mrs. Harriet Dowell, another trainee, and assigned to Dr. Winston Markoe’s ward.

“No fainting. No shrieking. No tears.” Dr. Markoe laid the ground rules as they followed him up to the second floor of the hospital. “Keep a sharp eye, write down anything you don’t want to forget, and cork down any of displays of emotions you might feel rising to the surface.” Tall and lanky, Dr. Markoe paused at the top of the stairs to allow them to catch up. He looked over the top of his spectacles down the beak of his nose at them with small, close-set black eyes. “Understand?”

Charlotte and Mrs. Dowell nodded.

“Good. Try to keep up. It will do you good to just become familiar with the cases for now. Lectures and more specific instruction will come later.”

Dr. Markoe turned and walked briskly to his first patient.

“How are we today, Briggs?”

Briggs didn’t respond. He didn’t even open his eyes. Dr. Markoe pulled his stethoscope out and listened to his heart rate.

“One hundred twenty beats a minute. Adam Briggs, chronic diarrhea, age nineteen,” the doctor said. “What observations can you make by just looking at him?”

“He must have lost a great deal of weight,” ventured Charlotte. The boy’s skin hung loosely over wasted muscles. His features looked pinched.

“Yes, sixty pounds, at least, have melted off his six-foot frame since the onset. What else?”

“His coloring isn’t quite right.” Mrs. Dowell squinted at his complexion.

“That opaque clay color comes from the disease,” said Dr. Markoe.

Charlotte leaned in a little closer now, hugging her notebook to her chest. “What’s on his skin?”

“Furfuraceous desquamation of epithelium.”

Charlotte stepped back.

“The poor dear is quite gone with it, then isn’t he?” Mrs. Dowell asked. Her son, she had told Charlotte, had also volunteered and was currently at Staten Island.

“I’m afraid he is. I’m going to open his mouth now.” Dr. Markoe pried open the boy’s jaws. “Now look at the tongue.” He pulled it out.

“Why, it’s blood red!” said Charlotte.

“Dirty red, I should say,” added Mrs. Dowell. “Like a piece of raw beef you’d get at the market.”

“Yes,” agreed Dr. Markoe. “An apt description. If you had seen him not long ago, the tongue would have been pale, swollen, smooth, watery, indented on the edges by the teeth, its papillae hardly perceptible. Patients who reach this stage very seldom recover,” he added in a low tone. “If he were to speak, you’d notice it would sound weak and feeble, as if you were hearing him from a great distance. You would also notice depression and confusion, which very often accompany chronic diarrhea.”

“Well, I should say so! And who wouldn’t be depressed about it?” interjected Mrs. Dowell.

“But no delirium, which seems to be the special characteristic of fevers. Of course, the abdomen is also tender. Evacuations from the bowels may occur as often as every fifteen minutes or more frequently than that. Usually it’s preceded by gripping pain. The discharges are liquid, and become darker from the presence of blood as the disease progresses. If he is eating indiscriminately, you’ll be able to see undigested food in the discharges.”

At this Charlotte paused from scribbling in her notebook to put up a hand. “Pardon me, Dr. Markoe, but is it really necessary to tell us all of this? We won’t be making the diagnoses ourselves, after all. Just following the doctor’s orders. Correct?”

The look in his eyes withered her. “My dear girl, if you cannot handle
hearing
of such things, how do you expect to walk among these poor men? Too weak to reach a toilet, they will need to be cleaned up, sometimes fed, their bedclothes changed. You must begin to think about it scientifically, rather than emotionally, and become accustomed to the sights, sounds, smells of the hospital.”

She felt her cheeks ignite in shame and vowed to hold her tongue from that point on.
Eyes open, mouth shut
, she told herself.

“Women nurses indeed,” she heard him mutter.

Briggs moaned then, and his eyelids fluttered open. One look into his eyes, and Charlotte’s stomach churned. His eyes closed again, and she looked at Dr. Markoe for an explanation.

“Yes, I was about to tell you about that. I have only seen it in two patients in this hospital. It’s an ulcer. It grows until it penetrates the cornea and evacuates the humors of the eye. From what I understand from other doctors, no patient has ever recovered who displayed this symptom.”

“What can you do for him?” Concern was etched into Mrs. Dowell’s brow.

“There is no point in any further treatment. If he were not so far along, we would have given him fresh fruits and vegetables, and given him opiates for the pain. But not now. It’s just too late.”

Charlotte looked at the boy again, and saw him as a person, not just a medical case. A boy, without even a shadow of stubble on his face. She tried to imagine what he had looked like before he had become emaciated. Before his complexion turned muddy, before his own skin betrayed him in great brown flakes. She was sure he had been handsome, full of life and energy, and only too anxious to defend his country. She wondered if he had a sweetheart, or if his heart still belonged to his mother or sisters.
How shocked they would be to learn he had died before a single battle took place.

“Where is his mother?” she asked, frowning.

“We’ve tried to find her.”

“What will you tell her?”

“Her son died bravely for a glorious cause.”

But he wasn’t dying for a cause. He was dying alone of a preventable disease before he even shouldered a rifle.

Charlotte couldn’t fathom the pain his mother would feel when she learned her son had died without her comforting touch. She reached out and touched his scaly arm, dry and brittle beneath her fingertips. She gently moved her fingers into his palm and felt the slightest twitch of his fingers.

“He knows I’m here?” she asked the doctor.

“It’s difficult to say,” Dr. Markoe replied. “He is so weak. I’m sure his bed will be empty before too—”

“Shhhhh, shhhhh, Adam,” Charlotte drowned out the doctor’s words. “It’s going to be all right. You’re doing fine.”

Dr. Markoe shook his head. All three of them knew it was a lie. Perhaps Adam knew it, too, but his body seemed to relax under her hands.

“If you please, we need to move on.” Dr. Markoe pushed the spectacles up his hawk-like nose.

“This boy is some mother’s son, Doctor, and if what you say is true, he is slipping from this world to the next right before our eyes. There
is
a place for compassion, Dr. Markoe, even in the midst of your scientific observations,” Charlotte told him as they turned to leave Adam’s side.

Dr. Markoe sighed, deeply, slowly. “Sympathy doesn’t save lives. Science does. Efficiency does. If you feel too deeply, it will cloud your judgment, slow you down. I know it’s hard for you women to understand—that’s why medicine has always been a man’s job. But try. So, shall we?”

For the next three hours, Charlotte and Mrs. Dowell followed on Dr. Markoe’s heels, examining dozens of patients with pneumonia, fever, measles, rheumatism, tuberculosis, and several others whose symptoms
were inconclusive. By eleven o’clock, Charlotte’s notebook had several pages of scribbled notes and her head was spinning.

It was time for a lunch break before the afternoon lectures would begin. But before Charlotte was dismissed, Dr. Markoe caught her attention.

“Miss Waverly, a moment, please.” She followed him into the hallway outside his ward.

“Yes, Doctor?”

“You’re awfully sure of yourself, young lady.” His small eyes bore into hers.

“Excuse me?”

“I’m tolerating your boldness because it’s your first day of training. But I can guarantee you, if you pass this course, if you actually get placed under an army surgeon, he will be looking for reasons to dismiss you. And you are giving him several.”

“I don’t understand!” Her spine tingled. She hadn’t done anything wrong.

“First and most obvious, you are young and attractive. You’ll be a distraction to the convalescent male nurses, to the medical students, and to the soldier patients themselves. And by distraction, I mean they will be tempted to interact with you in ways that will satisfy their hunger for female … companionship.”

Charlotte looked down, but her voice was firm. “Since I have kept to every regulation of the nursing uniform, I don’t know what else I can do to become even less attractive. What else would you have me do, shave my head?”

“Now that’s the second thing I’m referring to. Right there. Your quick tongue is going to get you in trouble. I understand your asking me questions in front of the patients because you are in training, and you are here to learn. But did it ever cross your mind that this is an exception, not the rule? If you question the surgeon like this after you’re given your assignment, it will appear as if—no, in truth, you
will
be—trying
to undermine his authority, as a man, as a doctor, and as a military authority.”

Charlotte narrowed her eyes into slits as she looked up at him. “You will forgive me, sir, if I do not understand why asking questions is such a threatening thing. Wouldn’t it benefit everyone if I really understood what was going on?”

Dr. Markoe sighed and rubbed the back of his neck beneath the stethoscope cord. “Your father died a while ago, didn’t he?”

She blinked. “Yes, twelve years ago, but I fail to see how that has anything to do with this.”

“It has everything to do with it, Miss Waverly. You’ve been without the leadership of a father for quite some time, and you’ve never been subject to a husband. I understand how this is new to you. But if you want to be accepted as a nurse, you will do as the doctor says and not ask questions. Asking questions implies that you do not trust the doctor’s decisions, his diagnosis, or his treatment. It implies that you could do it better. That he is incompetent. That’s grounds for dismissal.”

“But how can they do that if I’m given an assignment through Miss Dix?”

“Dorothea Dix is not taken seriously by most men in the army. She has power only to recommend, not to enforce. In other words, she might send you to a hospital for placement, but if the surgeon finds a reason to fire you—or fabricates one—out you’ll go. He’s still in charge.”

Charlotte felt her anger beginning to boil to the surface and fought to retain control of her voice. “What, then, Dr. Markoe, do you suggest Ido?”

His mouth tipped up in a smile that didn’t quite reach his eyes. “No need to be upset with me, Miss Waverly. I’m just giving you a bit of free advice. You seem to believe that being in this program means you’re ready to take charge and do things better. If you don’t drop that strong-minded, woman-of-reform attitude, no doctor, and I mean
not one
, will want to work with you. You haven’t proven anything yet, and what’s more, every step of the way you’ll be on the edge of losing what you’ve
gained. If you don’t like the sound of that, you might as well go home now.”

She remembered the words Caleb spoke to her at the dance.
What if your stepping out of formation was actually a step in the right direction?