Die Once Live Twice (16 page)

“I have a lump on my breast. I know about breast cancer. I nursed my mother through her final months as she died from it.”

Welch paled, shaken by this news. “I’m deeply sorry, Katherine.”

“Is there any new treatment?”

Welch spread his hands. “There is no cure, as you know. But Halsted has worked in the laboratory for the last year on a new technique for removing a cancerous breast.”

“Removing...?”

“He can explain better than I. Wait here. I will get him.”

Welch returned with Halsted, who had a powerfully built chest and shoulders and an athletic face. He had been the captain of the first football team fielded by Yale in 1873. His long white coat made him an intimidating figure, but he shook hands with Katherine deferentially. Welch excused himself and Halsted took Katherine into an adjoining room and removed her blouse, covering her with a medical gown—made with Donovan & Sullivan textiles, Katherine noted wryly. Halsted examined her breast and palpated the lump next to her nipple. It was three centimeters in diameter, with the overlying skin firm and dimpled like the skin of an orange. He felt under her armpit and there was a swollen lymph node. “I can only agree with your diagnosis,” he said gravely.

“William said you were working on a treatment.”

“It is still being refined. To speak openly, I need patients who will take the risk. Cutting out the tumor is the only way to try and stop it from killing you,” he said bluntly.

Katherine sat quietly, listening to Halsted describe this mutilating operation he called radical mastectomy. While doctors had attempted the removal of the breast as soon as anesthesia was developed enough to permit a long operation, Halsted had realized that it was equally important to remove the underlying muscle and the lymph nodes under the armpits. Just the thought of it caused her to feel pain. What if it didn’t work? Would all that pain be worth it? “Thank you, Doctor Halsted. I must discuss this with my sons. I will give you my answer by tomorrow.”

As Katherine told the boys of her disease and options, the blood drained from Jeffrey’s face. “Mother, please don’t let Halsted do this to you. He will kill you.”

She understood his fear. “Jeffrey, the cancer will kill me. I am under a death sentence, and Doctor Halsted is the only one who can offer me a reprieve.”

“He will kill you,” Jeffrey repeated, agonized at the thought of losing his mother.

“He is the greatest surgeon of our time,” Jonathan spoke up. “He performed a gallbladder operation on his own mother at home in their kitchen. She is still alive.”

“Let him experiment on his own family.”

“Jeffrey, you know that Mother has fought against the odds all her life. She pioneered roads women never would have traveled and she never considered quitting, even when things got tough. How can you ask her to quit now? She has to try this. It’s her one chance.”

Katherine turned to Jeffrey. “My son, I understand your fear. I couldn’t stand losing my own mother. But I want to do this. I know that my mother would have leaped at the chance to live—to see me grow and to live life longer. I have come to the conclusion that I have the courage and will to do this operation. I view it as the seminal event in the future of our family and my heirs. We have amassed all the wealth we could imagine. Now we need to use our money, our talents, and our lives to better humanity by finding cures. Infection and cancer are foremost to me. By having this operation I am leading the way for you. Whether I live or die, I want you to follow my example of forging new treatments for medicine. This is to be your calling, Jeffrey and Jonathan.”

Both of them sat quietly, surprised at this destiny their mother envisioned for them. She took their hands. “You know that I have always loved the story of Richard the Lionheart and his mother, Eleanor.”

“The most powerful woman in Europe,” Jeffrey said, remembering Katherine’s retelling of the story.

“And the richest,” Jonathan added.

“The conquest of disease is the great crusade of our time,” Katherine continued, “and I want you to lead it, as Richard did the Third Crusade. My challenge to you is to find the Holy Grail—the ability to face certain death and conquer it, to live twice.”

Jeffrey and Jonathan looked at each other. Jeffrey looked down for a moment, then said to his mother, “I accept.”

Jonathan rose and paced across the room, then back again. “So...” he paused. “Which one of us gets to be Richard?”

Chapter Fifteen

P
rofessor William Halsted strode confidently into the amphitheater, his bearing as regal in his white cotton gown as in his finest evening suit. His fastidiousness about personal appearance was well known to his students and merely added to the allure of the man about whom they knew little but nonetheless aspired to emulate. The anticipation of watching him perform an historic operation added to the air of exhilaration and tension. The surgical amphitheater at Hopkins, with its circular rows of wooden benches, allowed students a rare opportunity to witness Halsted’s talent and techniques as he operated in the pit.

Miss Caroline Sharpe, the chief operating room nurse and Halsted’s long-time scrub nurse, was standing next to the doctor administering anesthesia. She spoke softly to Katherine, whose eyes showed fear. The chloroform quickly induced unconsciousness and many of the students bowed their heads in a silent prayer for her safe return to consciousness.

The surgical team sterilized their hands and arms with Lister’s antiseptic solution, carbolic acid, and put on rubber gloves. Miss Sharpe was allergic to the antiseptic solution so Halsted had designed rubber gloves so she could continue to scrub with him. The team gently but thoroughly washed Katherine’s right chest, breast, upper arm, and armpit with carbolic acid. They covered her exposed breast with permanganate solution, which left her skin purple-brown.

Halsted’s operation, a radical mastectomy, had never been attempted by him before. Taking a deep breath to quiet his nerves, Halsted said to his assistant, Doctor Howard Kelly, “I truly believe in my heart that I can remove the entire tumor.” Kelly, one of the original four surgeons of Johns Hopkins, seconded the belief. “Today is the start of a living experiment,” Halsted said as he prepared for the first cut. He placed his hands upon Katherine’s chest and closed his eyes for a brief moment.
I know there must be a Supreme Being, and it is not me. I pray for His blessing as I embark into this new frontier.

“Miss Sharpe, may I have the syringe of cocaine?” he asked. As she handed it to him, he wished briefly that he had injected himself, to calm his nerves. “The cocaine will enhance the chloroform,” Halsted told the students in a loud voice. “It will act to block the nerves from transmitting pain signals. Miss Sharpe, please keep an extra syringe of cocaine at the ready as I advance through the operation. Doctor Kelly, are you ready to start?” he asked. Kelly nodded and Halsted heard a chorus of squeaking wood as the audience watching above moved forward in their seats.

Halsted began by making a circumferential incision away from the breast tissue. When he cut the skin and fat, many small vessels began to pump blood into the wound. He clamped them. “Miss Sharpe, be sure that we have plenty of serrefines. Blood control will be tedious.” Halsted had designed a “mosquito forceps,” which had a small tip specifically designed to allow the clamping of bleeders. This device, a result of his vascular studies with animals and cadavers, saved the tissues surrounding the vessel. He firmly grasped the breast and pulled on it to create tension so that tissues he was dissecting would separate more easily. He wondered just how many times the patient’s husband had caressed this breast during nights of passion and marveled that in just hours her life would be forever changed. The violation of his patient’s body, though necessary, was never lost on him.

Halsted’s assistant retracted and exposed tissue for him, anticipating his every move. He tied off bleeders as Halsted clamped them and at times even found himself impatient with Halsted’s methodical pace.
Good God, man,
Kelly thought,
the patient’s tissues will be healed by the time you finish.
Had Kelly uttered his words out loud it was doubtful that Halsted would have heard them, so focused was he on his work. Following the master plan in his head, he began cutting the pectoralis muscle and freeing it from the smaller pectoralis minor muscle.

Kelly carefully retracted the mass of breast, fat, and muscle tissue so that Halsted could then cut away the pectoralis minor muscle. The entire tissue mass had to be removed en block or all his work might be for naught. If he cut through the tumor it would seed the wound with cancer cells, which would spread rampantly. If Kelly relaxed his traction on the breast, the wound would flood with blood. Halsted had at least ten veins to separate and ligate to free the entire tissue mass for total exposure of the axilla.

In the armpit were the largest blood vessels and nerves and to err here would be disaster. Miss Sharpe, aware of Halsted’s dilemma, mutely began passing him mosquito forceps, followed by a ligature, followed by a forceps, and finally another ligature in a steady rhythm. He could feel beads of perspiration dotting his forehead. His need to be perfect had started to make him anxious as he painstakingly tied one vein, then another, then another until all ten had been tied off.

His hands now worked automatically. The operation was in its third hour, but he was near its finish. He recalled the numerous cadavers he had used to perfect his skill at dissecting the nodes and fat, and the memory made his heart beat faster. He exposed the subclavian vein, which he needed to identify to avoid damaging it. Should he do so, her arm would be left useless from pain and swelling. The arm would swell enough as it was from the removal of the lymph glands.

Preparing for the end of the surgery, he tied each small axillary vessel without any extraneous tissue so as to leave no tumor behind. As he eased the knife along the tissue, blood suddenly filled the wound. He had lacerated the subclavian vein. His stomach tightened and his breathing increased. Miss Sharp immediately began soaking up the blood in the wound with gauzes, but everyone knew that death would follow unless he and Kelly found a way to stop the deluge. There was no way to give his patient new blood. If he clamped the entire vein, he would permanently injure it.

Kelly came to the rescue by clamping a mosquito forceps on one cut edge of the vein, allowing Halsted to control the bleeding by covering the hole with his finger. With the other cut edge visible, he now placed a mosquito clamp precisely and closed the laceration with a suture. He prayed the blood flow would be strong and uninterrupted once the silks were firmly knotted. The air in the room grew thick. He knew his audience was wondering if he had made a fatal mistake. To his relief the blood flowed freely in the vein without any leakage. He huffed to himself that the only fluid flowing outside the vein was the sweat on his forehead, which had fully soaked his cap.

He trusted no one but himself to complete the operation. Infection would destroy any hope for a cure. Using silver wire he closed the tissue just under the skin and watched patiently as the wound oozed blood, filling the dead space in the wound. His research had shown that clotted blood in such dead spaces promoted healing, and he believed this technique should be incorporated into every closure. As he handed Miss Sharpe his suture needle he took a brief moment to thank Kelly, who had clearly eased his burden this day.

The crowd stood and erupted into applause. Halsted felt a deep rush of pride. He nodded at Miss Sharpe. She handed him a syringe of cocaine as he turned and retreated into the privacy of the adjoining room. Once he was alone, he injected the needle into his own arm. With the cocaine’s full sensation racing through his bloodstream, Halsted discarded his soiled operating gown and the syringe. Leaning against the counter he closed his eyes with the somber knowledge that even in his finest hour his demons still owned him.

At the 1893 opening ceremony for the Johns Hopkins Medical School, Mary Garrett was honored for her vision in enabling the school to become reality. Katherine Sullivan, who was a pillar in its funding, beamed at the first class of eighteen students, fifteen men and three women, seated in the front rows. The best-looking student, she was sure, was Jeffrey Sullivan. Katherine said a silent prayer to her doctor, thanking his research and surgical skills, which had rescued her from her time to die and given her a second life. She felt satisfaction that she had kept her promise to her mother that she would do something about making medicine better. She was confident her sons would carry on her crusade.