The Cole Trilogy: The Physician, Shaman, and Matters of Choice (100 page)

Rob J. Cole first saw the New World on a foggy spring day as the packet
Cormorant
—a clumsy ship with three squat masts and a mizzen sail, but the pride of the Black Ball Line—was sucked into a commodious harbor by the incoming tide and dropped its hook in the choppy swells. East Boston wasn’t much, a couple of rows of ill-built wooden houses, but from one of the piers, for three pence he took a little steamboat ferry that threaded its way through an impressive array of shipping, across the harbor to the main waterfront, a sprawl of tenements and shops smelling reassuringly of rotting fish, bilges, and tarred rope, like any Scots port.

He was tall and broad, larger than most. When he walked the crooked cobblestoned streets away from the water, it was hard going because the voyage had made him bone weary. On his left shoulder he bore his heavy trunk, while under his right arm, as if he carried a woman by the waist, was a very large stringed instrument. He absorbed America through his pores. Narrow streets, scarcely allowing room for wagons and carriages. Most buildings of wood or constructed of very red brick. Shops well-supplied with goods, flaunting colorful signs with gilded letters. He tried not to ogle the females entering and leaving the shops, although he had an almost drunken urge to smell a woman.

He peeked into a hotel, the American House, but was intimidated by chandeliers and Turkish carpets, knowing its rates were too high. In an eating house on Union Street he had a bowl of fish soup and asked two waiters to recommend a boardinghouse that was clean and cheap.

“Make up your mind, lad, it’ll either be one or the other,” one of them said. But the other waiter shook his head and sent him to Mrs. Burton’s on Spring Lane.

The one available room had been built as servants’ quarters and shared the attic with the rooms of the hired man and the maid. It was tiny, up three flights of stairs to a cubby under the eaves, certain to be hot in the summer and cold in the winter. There were a narrow bed, a little table with a cracked washbowl, and a white chamber pot covered by a linen towel embroidered with blue flowers. Breakfasts—porridge, biscuits, one hen’s egg—came with the room for a dollar and fifty cents a week, Louise Burton told him. She was a sallow widow in her sixties, with a direct stare. “What is that object?”

“It’s called a viola da gamba.”

“You earn your living as a musician?”

“I play for my pleasure. I earn my living as a doctor.”

She nodded doubtfully. She demanded payment in advance and told him of an ordinary off Beacon Street where he could get his dinners for another dollar a week.

He fell into the bed as soon as she was gone. All that afternoon and evening and night he slept, dreamless save that somehow he still felt the pitch and toss of the vessel, but in the morning he awakened young again. When he went down to attack his breakfast, he sat next to another boarder, Stanley Finch, who worked in a hatter’s shop on Summer Street. From Finch he learned two facts of prime interest: water could be heated and poured into a tin tub by the porter, Lem Raskin, at a charge of twenty-five cents; and Boston had three hospitals, the Massachusetts General, the Lying-in, and the Eye and Ear Infirmary. After breakfast he soaked blissfully in a bath, scrubbing only when the water cooled, and then labored to make his clothing as presentable as possible. When he came down the stairs, the maid was on her hands and knees washing the landing. Her bare arms were freckled, and her gluteal roundnesses quivered with the vigor of her scrubbing. A sullen tabby’s face looked up at him as he passed, and he saw that beneath her cap her red hair was the color that pleased him least, the shade of wet carrots.

At the Massachusetts General Hospital he waited half the morning and then was interviewed by Dr. Walter Channing, who wasted no time in telling him the hospital needed no additional physicians. The experience was quickly repeated at the other two hospitals. At the Lying-in, a young doctor named David Humphreys Storer shook his head sympathetically. “Harvard Medical School turns out doctors every year who have to stand in line for staff appointments, Dr. Cole. The truth is, a newcomer has little chance.”

Rob J. knew what Dr. Storer wasn’t saying: some of the local graduates had the help of family prestige and connections, just as in Edinburgh he had enjoyed the advantage of being one of the medical Coles.

“I would try another city, perhaps Providence or New Haven,” Dr. Storer said, and Rob J. muttered his thanks and took his leave. But a moment later, Storer came hurrying after him. “There is a remote possibility,” he said. “You must talk with Dr. Walter Aldrich.”

The physician’s office was in his home, a well-kept white frame house on the south side of the meadowlike green they called the Common. It was visiting hours, and Rob J. waited a long time. Dr. Aldrich proved to be
portly, with a full gray beard that failed to hide a mouth like a slash. He listened as Rob J. spoke, interrupting now and again with a question. “University Hospital in Edinburgh? Under the surgeon William Fergusson? Why would you leave an assistantship like that?”

“I’d have been transported to Australia if I hadn’t fled.” He was aware his only hope was in the truth. “I wrote a pamphlet that led to an industrial riot against the English crown, which for years has been bleeding Scotland. There was fighting, and people were killed.”

“Plainly spoken,” Dr. Aldrich said, nodding. “A man must struggle for his country’s welfare. My father and my grandfather each fought the English.” He regarded Rob J. quizzically. “There is an opening. With a charity that sends physicians to visit the city’s indigent.”

It sounded like a grubby, inauspicious job; Dr. Aldrich said most visiting physicians were paid fifty dollars a year and were happy to receive the experience, and Rob asked himself what a doctor from Edinburgh could learn about medicine in a provincial slum.

“If you’ll join the Boston Dispensary, I’ll arrange for you to assist evenings as docent in the anatomy laboratory of the Tremont Medical School. That will bring you another two hundred and fifty dollars a year.”

“I doubt I can exist on three hundred dollars, sir. I have almost no funds.”

“I have nothing else to offer. Actually, the annual income would be three hundred and fifty dollars. The work is in District Eight, for which the dispensary’s board of governors recently voted to pay the visiting physician one hundred dollars instead of fifty.”

“Why does District Eight pay twice as much as other areas?”

Now it was Dr. Aldrich who chose candor. “It is where the Irish live,” he said in a tone as thin and bloodless as his lips.

Next morning Rob J. climbed creaking stairs at 109 Washington Street and entered the cramped apothecary’s shop that was the Boston Dispensary’s only office. It was already crowded with physicians awaiting their daily assignments. Charles K. Wilson, the manager, was brusquely efficient when Rob’s turn came. “So. New doctor for District Eight, is it? Well, the neighborhood’s been unattended. These await you,” he said, handing over a wad of slips, each bearing a name and address.

Wilson explained the rules and described the eighth district. Broad Street ran between the ocean docks and the looming bulk of Fort Hill. When the
city was new, the neighborhood was formed by merchants who built large residences in order to be near their warehouses and waterfront businesses. In time, they moved on to other, finer streets, and the houses were occupied by working-class Yankees, then in turn by poorer native tenants as the structures were subdivided; and finally by the Irish immigrants who came pouring from the holds of ships. By then the huge houses were run-down and in disrepair, subdivided and subrented at unfair weekly rates. Warehouses were converted into hives of tiny rooms without a single source of light or air, and living space was so scarce that beside and behind every existing structure there had risen ugly, leaning shacks. The result was a vicious slum in which as many as twelve people lived in a single room—wives, husbands, brothers, sisters, and children, sometimes all sleeping in the same bed.

Following Wilson’s directions, he found District Eight. The stink of Broad Street, the miasma given off by too few toilets used by too many people, was the smell of poverty, the same in every city in the world. Something within him, tired of being a stranger, welcomed the Irish faces because they shared his Celticness. His first ticket was made out to Patrick Geoghegan of Half Moon Place; the address might as well have been on the sun, for almost immediately he became lost in the maze of alleys and unsigned private ways that ran off Broad Street. Finally he gave a dirty-faced boy a penny to lead him into a tiny crowded court. Inquiries sent him to an upper story of a neighboring house, where he made his way through rooms inhabited by two other families to reach the tiny quarters of the Geoghegans. A woman sat and searched a child’s scalp by candlelight.

“Patrick Geoghegan?”

Rob J. had to repeat the name before he won a hoarse whisper. “Me Da … dead these five days, of brain fever.”

It was what the people of Scotland, too, called any high fever that preceded death. “I’m sorry for your trouble, madam,” he said quietly, but she didn’t even look up.

Downstairs he stood and gazed. He knew every country had streets like this, reserved for the existence of injustice so crushing it creates its own sights and sounds and odors: a whey-faced child seated on a stoop gnawing a bare bacon rind like a dog with a bone; three unmatched shoes worn beyond all repair, adorning the littered dirt lane; a drunken male voice making a hymn of a maudlin song about the green hills of a fled land; curses shouted
as passionately as prayers; the smell of boiled cabbage dampened by the stink, everywhere, of overflowed drains and many kinds of dirt. He was familiar with the poor neighborhoods of Edinburgh and Paisley, and with the stone row houses of a dozen towns where adults and children left home before daybreak, plodding to the cotton factories and woolen mills, not to drag themselves home until well after night had fallen again, pedestrians only of the dark. The irony of his situation struck him: he had fled Scotland because he’d fought the forces that formed slums such as this, and now in a new country his nose was being rubbed in it.

His next ticket was for Martin O’Hara of Humphrey Place, a shed-and-shanty area cut into the slope of Fort Hill and reached by means of a fifty-foot wooden stairway so steep as to be virtually a ladder. Alongside the stairway was a wooden open gutter down which the raw wastes of Humphrey Place oozed and flowed, dropping to add to the troubles of Half Moon Place. Despite the misery of his surroundings, he climbed quickly, becoming acquainted with his practice.

It was exhausting work, yet at the end of the afternoon he could look forward only to a meager, worried meal and an evening at his second job. Neither job would provide him with money for a month, and the funds he had left wouldn’t pay for many dinners.

The dissection laboratory and classroom of the Tremont Medical School was a single large room over Thomas Metcalfe’s apothecary shop at 35 Tremont Place. It was run by a group of Harvard-trained professors who, disturbed by the rambling medical education offered by their alma mater, had designed a controlled three-year program of courses they believed would make better doctors.

The professor of pathology under whom he would work as dissection docent proved to be a short, bandy-legged man about ten years older than himself. His nod was perfunctory. “I am Holmes. Are you an experienced docent, Dr. Cole?”

“No. I’ve never been a docent. But I’m experienced at surgery and dissection.”

Professor Holmes’s cool nod said: We shall see. He outlined briefly the preparations to be completed before his lecture. Except for a few details, it was a routine with which Rob J. was familiar. He and Fergusson had done autopsies every morning before going on rounds, for research and for the practice that enabled them to maintain their speed when operating on the
living. Now he removed the sheet from the skinny cadaver of a youth, then donned a long gray dissection apron and laid out the instruments as the class began to arrive.

There were only seven medical students. Dr. Holmes stood at a lectern to one side of the dissection table. “When I studied anatomy in Paris,” he began, “any student could buy a whole body for only fifty sous at a place that sold them each day at high noon. But today cadavers for study are in short supply. This one, a boy of sixteen who died this morning of a congestion of the lungs, comes to us from the State Board of Charities. You will do no dissecting this evening. At a future class the body will be divided among you, two of you getting an arm for study, two a leg, the rest of you sharing the trunk.”

As Dr. Holmes described what the docent was doing, Rob J. opened the boy’s chest and began to remove the organs and weigh them, announcing each weight in a clear voice so the professor could record it. After that, his duties consisted of pointing to various sites in the body to illustrate something the professor was saying. Holmes had a halting delivery and a high voice, but Rob J. quickly saw that the students considered his lectures a treat. He wasn’t afraid of salty language. Illustrating how the arm moves, he delivered a ferocious uppercut at the air. While explaining the mechanics of the leg, he did a high kick, and to show how the hips worked, a belly dance. The students ate it up. At the end of the lecture they crowded around Dr. Holmes with questions. As the professor answered them, he watched his new docent place the cadaver and the anatomical specimens in the pickling tank, wash down the table, and then wash and dry the instruments and put them away. Rob J. was scrubbing his own hands and arms when the last student left.

“You were quite adequate.”

Why not, he wanted to say, since it was a job a bright student could have done? Instead, he found himself asking meekly if advance payment was possible.

“I’m told you work for the dispensary. I worked for the dispensary myself once. Goddamned hard work and guaranteed penury, but instructional.” Holmes took two five-dollar notes from his purse. “Is the first halfmonth’s salary sufficient?”