When We Were Strangers (28 page)

Chapter Sixteen
An Obstruction

In the morning,
while Mrs. Robbins continued our anatomy drills, Dr. Bucknell called me to translate for a patient doubled over in her office. “She’s Italian, we know that much,” said Dr. Bucknell. “The complexion is sallow, as you see, the pulse elevated and she manifests considerable abdominal pain.”

I drew my chair close to the young woman, who seemed to be my age and wore the plain cotton dress of a factory girl. She said her name was Francesca De Santis and she worked at Mr. Levi’s factory on Battery Street, sewing pockets onto the trousers that people called blue jeans. Her accent rippled through me and I nearly wept for joy. She was from Abruzzo and seemed freshly in America, still bearing the smell of our earth and savor of our bread.

“Family here?” Dr. Bucknell had me ask.

“No one now,” Francesca said. “I came last month to join my sister, but she had already died of pneumonia.”

When I gave my condolence and said that I was alone in America too, she leaned closer, as if tasting my words. “How long have you been in this country, Francesca?” I asked.

“Who are you?” she whispered.

“Irma Vitale of Opi. I am a student here.”

“Opi?” she breathed. “So close. I’m from Scanno.”

Scanno! “On a clear day we see your village.”

“And we see Opi.” Buttons of sweat crowded her brow as she stretched a pale hand toward mine. I grasped it.

“When you’re better, Francesca, we’ll talk about home. We’ll—”

Dr. Bucknell coughed lightly. “Symptoms?”

“Francesca, the doctor asks where it hurts you.”

She pointed to her belly below the navel, but the finger wavered. “There. But it moves, like a snake, hot.”

I translated for Dr. Bucknell, whose pen scratched over a blast of laughter from the street below us. “So the pain shifts locus. See if the tongue is coated.” It was. “Ask what treatment she has had so far.”

“I tried mustard water to bring vomiting and then a man at the factory said I should swallow bullets.”

“Bullets?” I gasped. “
Lead bullets?
”

“Yes, he said the weight would push out an obstruction. I took them and walked home, but then I must have fainted. Someone brought me here.”

Dr. Bucknell threw down her pen when I translated. “Idiots! Pure idiots! Never mind, let’s get her to bed. We’ll try to treat without operating.” Yes, Sofia always said that to open the belly makes a gaping door to infection.

Francesca tugged me closer. “Irma,” she whispered, “there’s blood when I pass water.”

I translated for Dr. Bucknell, whose muttered “huh” shot a wave of terror across the pale face. Sofia had never shown the slightest jolt at any patient’s story. Now Francesca gripped me with desperate strength. “Will I die? Will I see Scanno again? I promised Mamma I’d come back.”

“We’ll take care of you. You’ll see Scanno again.”

Francesca closed her eyes.

I whispered to Dr. Bucknell. “We can help her, can’t we? She’ll live?”

“Be careful of promises, Miss Vitale,” said Dr. Bucknell. “We’ll do our best.”

With Susanna I helped Francesca into a linen shift and had her eat a little broth. We applied poultices to the abdomen and dosed her with calomel, sodium bicarbonate and pepsin. We gave morphine for pain and woke her to pass urine streaked with bloody ribbons. The lead bullets never emerged. I brushed her hair and sang an Opi song, but with each passing hour she drifted further into a private world of pain.

In the morning Dr. Bucknell called the students to Francesca’s bed, explained the symptoms and had them prod the belly to feel its heat and tightness. “There is an obstruction and massive infection,” she explained in the next room. “Possibly in the appendix.”

“What is the treatment?” Susanna asked.

“Generally, opium to ease the patient into death. However we can try, at least, to drain off the worst of the infection. She’s young and her body may expel the rest. I have summoned Mr. Benjamin.”

A plump, dapper young man soon presented himself with a gauze-topped jar of leeches moving languidly in the clouded water. “The very finest specimens, imported from France,” Mr. Benjamin boasted. “My last of this shipment and exquisitely famished. Each one is fifty cents.” He examined Francesca, sounded and smelled her. “She may require ten,” he warned.

“Then apply ten, sir,” said Dr. Bucknell. “And quickly, please.”

Mr. Benjamin reached in the jar and pulled out a leech, which he laid on Francesca’s belly, holding gently until its head burrowed into the taut skin. He attached another and another until she was draped with pulsing black ribbons. “They will eat for an hour,” he said and produced a slim book of poetry that he proceeded to read as his charges swelled to thick fingers. Francesca murmured but did not wake. When the leeches ceased to pulse, he plucked them off easily and dropped them into a wooden box. He would empty them in our cesspit, Dr. Bucknell explained. High-quality leech masters used fresh beasts for each patient. “They have done their job well,” Mr. Benjamin said.

In fact there was some flattening of the belly and the skin did seem to soften. Francesca awoke and asked for water in a voice that was nearly her own. “Rest now,” Dr. Bucknell told us. “We may need you later.” I put a chair by Francesca’s bed and finally closed my eyes.

By midnight, Francesca’s moaning cut me from sleep. The tiny wounds were spitting pus and the dark, swollen belly was ghastly. I sent Susanna racing for Dr. Bucknell, who examined Francesca and then stepped sadly back. “Too much infection,” she sighed. “If it continues, she will die.”

“More leeches?” I suggested.

“No, they’ve done all they can. I have just read an account by Dr. Morton of Philadelphia of a grocer with similar symptoms. He too, attempted a cure with leeches. When they did not suffice, he opened the abdomen, cleaned it of pus, tied off and removed the appendix. The next patient treated thus did not survive, but the grocer was utterly cured. We must operate. It is our only chance for this girl. Try to get her consent.”

I woke Francesca and explained what the doctor had said. “No,” she gasped. “My father died from cutting. I saw him.” She clenched my smock. “Get Mamma. Oh Irma, it hurts so much.”

“Francesca, please let us try. The doctor is very skilled.”

A wave of pain convulsed her. “Make it stop, Irma! Make—stop.”

“Let us operate.” The wild hands flailed. “Francesca, it’s your only chance.”

She found my arm again and gripped it. “You’ll stay with me, Irma?”

“Yes, I’ll be right here, but please let the doctor operate.”

She nodded and closed her eyes, still gripping my hand.

“Miss Vitale?”

“She consents.”

Dr. Bucknell studied the account from Philadelphia again as Susanna and I sterilized tools, prepared the operating table and washed Francesca’s belly. Other students filed into the room and pressed against the walls, hands over their mouths.

“Phew, worse than a cesspit,” one of them whispered.

“Miss Miller,” said Dr. Bucknell severely, “there is no cause to dwell on the obvious.”

Francesca’s lips moved in prayer. After she crossed herself I took her hand as Dr. Bucknell brought the glass tube of the ether chamber to her mouth and had her breathe deeply. When a pinprick brought no response, Dr. Bucknell poised a scalpel over the taut belly. “We’ll begin,” she said, “and proceed as quickly as possible.”

The cut gaped open, a terrible mouth. Foul streams of corruption drained into basins that Susanna handed to students who hurried them away. How could such corruption be within a body and that body live? “The bullets,” Dr. Bucknell muttered, dropping three into a basin where they rattled like cherry pits. In the pulsing red mass, she found the appendix, tied it off with silk thread, then removed it neatly and closed the aperture with tiny stitches.

“Warm water,” she ordered, and Susanna brought a beaker. “Gauze.” She mopped the oozing blood and then folded back the skin. “Miss Vitale, you may finish,” said Dr. Bucknell, and directed my first abdominal suture. When I had tied off the last stitch, she stepped away from the table and Susanna removed her blood-splattered jacket. “Now all we can do is to keep her comfortable. Give morphine for pain. We are in the hands of the Almighty.”

At first Francesca slept quietly. Her heart pumped more strongly, her breathing slowed and the fever declined. “These are good signs. I’ll record our procedures and then rest awhile,” said Dr. Bucknell. “Wake me if I’m needed.”

I sat by Francesca, holding her hand. “You’ll see Scanno,” I whispered. “You’ll see your mother.” I convinced myself that she was better, that with her quickening breath she was surely fighting infection. When she shivered, I laid a blanket over her and then another, closed the window and stoked the coal fire.

“Irma,” said Susanna when she came to relieve me, “blankets won’t help now.” She clamped my hand over Francesca’s wrist and I felt the racing pulse.

“Her heart is pumping,” I insisted frantically. “She’s stronger, no?”

“Irma, step away,” said Susanna gently and rang the bell for help. Someone opened the window and dampened the fire. Someone else brought whiskey and said that I must drink it. Dr. Bucknell hurried in. As if watching a dumb play, I saw Susanna leave and return with a priest, who touched Francesca’s brow with holy oil, prayed and left.

Her breath came in puffs now. Blue tinged her hands and the rim of her face. Once she opened her eyes and whispered: “Mamma.”

“Francesca, come back,” I called wildly, but the only answer was a terrible slow gurgle deep in the throat. A cable car rattled by. There were shouts from late drinkers in the tavern, dogs barking and boys playing stickball. Somewhere in that clatter, Francesca’s chest heaved and her pulse eased to nothing. I closed her eyes and stood, reeling. Dr. Bucknell drew me away. “Why?” I demanded. “We followed the procedure. We cleaned everything.”

“Surgery is always a risk. Remember, the grocer lived but the next patient died. Still, it was her only chance.” She wiped her brow. “Perhaps we were too late.”

“She trusted me. I promised she’d go home!”

Dr. Bucknell grasped my hands. “We’ll do an autopsy, Irma.”

Like the doctors’ men
. “No. Please, no.”

“With an autopsy,” she continued calmly, “perhaps we’ll learn why we failed. Then we will bury her decently and send a telegram to her family. You know we did our best for her.”

I nodded as exhaustion overwhelmed me. At least her mother would know that Francesca had not died among strangers. I made my way home in a cloud of doubt. In Madame’s shop we could imagine and sketch a gown, a riding habit, then cut and create it exactly as we imagined. Women were always happy with our work. Cutting into Francesca, we had made her suffer more and uselessly.

“You were unlucky this time, but you helped so many,” Molly insisted.

“I promised she’d go home. I promised!”

“Perhaps she did. Perhaps she sees it now.”

That night I watched stars slowly pass, praying that Francesca’s soul had found its way to Scanno.

Chapter Seventeen
Burning Waves

In the days after Francesca’s funeral,
treatments and pieces of anatomy that I knew as well as embroidery stitches flew out of my mind, leaving me mute in lessons and flooded with doubt. Perched at the rim of America, where could I go, what could I do if my nursing dream failed? Meanwhile, in the foul ships moored at the Barbary Coast, men began complaining of abdominal pains, headache and malaise. Newspapers blamed the men’s chronic drunkenness but Dr. Bucknell feared typhoid fever. “If you can’t concentrate on lessons, Miss Vitale,” she said, “you can work in the clinic.” Until we knew the certain cause of this sickness, there would be no operations, no cutting or bloodletting, she explained, just keeping the men clean and comfortable in cool, airy darkness. Endlessly sponging the brows of fevered, delirious old miners and vagabonds brought a peculiar rest and calm. If the disease was typhoid, at least the men would not die of a cure I had forced upon them.

On the fourth day I was called to stitch up a carpenter’s arm. “Miss Miller could do it,” I told Dr. Bucknell.

“It’s deep, with risk of infection,” she said, “and your antisepsis is better. I’d sew him myself but they’re bringing more men from the ships. Suture the carpenter and try to reassure him. He’s convinced he’ll lose the arm.”

Heat lapped over me. “I’m afraid. I promised Francesca and she—”

Dr. Bucknell set her hands on my shoulders. “Just clean the wound well. It’s laceration without complications. You know the treatment as well as I. Your Sofia, what would she say?”

“To follow Mr. Lister’s measures and sew the carpenter cleanly.”

“Well then, do that.” She gave me a handkerchief to dry my face. “He’s in the waiting room—the red-haired one, but he says that he’s Greek.”

Rags binding the carpenter’s arm were soaked with blood. He was broad shouldered, with wide brown eyes that watched anxiously as I exposed the wound. “You’re the Italian?” he asked in English. “The best for sewing, the doctor said.”

“Yes, I’m ‘the Italian.’ I used to be a dressmaker.”

The taut face relaxed a little. “A dressmaker? That’s good.”

The gash ran down most of the length of his arm. I shifted my body to block his view. “What is your name?” I asked over my shoulder.

“Niko Pappas, from the island of Kos, in Greece. And yours?” He peeked around me at the wound. “It’s bad, no? Very deep.”

“My name is Irma Vitale. It’s deep, but clean at least. How did this happen? Sit back, please, and tell me.”

“My partner and I were working on Sacramento Street. The scaffolding collapsed and I fell through a window.” Niko grasped my arm with his free hand. “There was a German on our crew with a smaller cut than this. They stitched him up and at first he was fine, but then the arm turned black and he lost it. Miss Vitale, carpentry is my work.”

Be careful of promises
. “I’ll do my best, Niko. I promise you that. Shall we close the wound?” When he nodded, red curls bounced on the moist forehead. “If you like, I’ll explain what I’m doing.”

“Yes, please.” He brushed back his hair.

“I’m scrubbing my hands and arms with lye soap.” I scrubbed them red. “Now I set fresh linen on the table. The suturing thread will touch no unclean surface. Now the needle is sterilized. Do you want someone to hold your arm?” He shook his head. “Then I’ll strap it down, swab the skin with extract of cocoa leaves to dull the pain and plan the stitches . . . Shall we begin?”

“Yes. Tell me about your home,” he said, turning toward the window and gripping the chair with his free hand. I described Opi, how small our village was and in what a forgotten corner of Abruzzo. I spoke of our sheep, our wine and cheese, the little piazza around our church and the view from our mountain at sunset.

The hand on the chair released. The coca was working. “Kos is also very small, with a small name, but it too is very beautiful.”

“Tell me about Kos.”

I bent over the arm as he described whitewashed houses perched by a blue sea, the fragrance of lemon groves and ripe figs and everywhere the dusty green of olive trees. Our
neighbors’
olive trees,” he added sharply, turning from the window to me. “Where did you learn dressmaking?”

“In Chicago.”

“And your dresses were beautiful?”

“The customers thought so.” The stitching was half done. “It will scar. I’m sorry.”

“That doesn’t matter if the arm is good. Dresses have seams, no? And wood joins to wood in a seam, no?”

“I never thought of that.”

“America is a grand country for wood, you know.” I nodded, bent over my work. “Have you walked in redwood forests, across on the ferry to Marin and up the coast?”

“No, not yet.”

Dr. Bucknell walked quietly into the room as Niko described misty groves of trees born before Christ, wide as a house and higher than any cathedral. Twelve men could stand on a cut tree and the fresh wood was a deep burnished red.

“Like your hair?” I asked without thinking.

He smiled broadly. “Perhaps yes. And yours is like oak.”

“Nearly finished. Three, two, one.” I snipped the last thread. No line of my stitching in skin had ever been finer.

“Excellent work,” pronounced Dr. Bucknell. “Have him return next week to remove the sutures.”

“Could Miss Vitale do it?” Niko asked.

The steady gaze of the wide brown eyes was too pressing and warm. “The others need practice,” I reminded Dr. Bucknell.

“That’s true,” she agreed hurriedly, for Mrs. Robbins was calling her. I bandaged the arm, explained how often to change the dressings, and gave him fresh gauze. When he struggled to put on his jacket, I helped but quickly stepped away.

“Your face is red,” Susanna whispered when I passed her in the hallway. “What’s wrong?”

“Nothing.”

“What happened at the dispensary?” Molly asked that evening.

“Nothing. It was an ordinary day.”

“Well, it wasn’t ordinary here. Mrs. Sullivan and I are buying the house next door. I found an Italian bank that will loan us money. You don’t have to be rich. There was a Greek carpenter ahead of me.”

“What was he like?”

Molly glanced at me sharply. “Looked like an ordinary Greek: big, loud, with black hair. Why do you ask?”

“No reason.”

“Well then,” she said eagerly, “I’ll show you the plans.” For the rest of the evening, I held my pounding head as Molly explained how she and Mrs. Sullivan would have the two houses connected, enlarging the dining room and thus doubling the number of boarders they could feed from one kitchen. Once the loan was repaid, Molly would be ready to buy her own boardinghouse. When I left her at midnight, she was filling a new calendar with tiny numbers. The stairs to my room seemed as steep as a mountain path. I was too tired for undressing and slept in my clothes with a wet cloth over my brow to ease the pain.

Our patients were worse the next day with more coming nearly every hour. Now even the newspapers spoke of typhoid fever. We washed patients and changed sheets, wearing masks against the foul smell of excrement that looked precisely as Dr. Bucknell termed it: “pea soup diarrhea.” During the Crimean War, she reminded us, Florence Nightingale reduced typhoid mortality to 50 percent with improved sanitation. Students were put to boiling sheets, washing chamber pots and even boiling the drinking water. I scanned the rows of moaning men. Which half would die? I held my head. “Miss Vitale,” said Dr. Bucknell. “You’re exhausted. First Francesca and now these cases. Go home. You need rest. Sisters from the convent on Powell Street are coming to help us.”

“But there’s work—”

“There’s always work. Go home.”

Susanna brought my coat and I stepped into the soothing foggy cool of the street, but once I was free of the patients with their constant cries for help, my strength drained away. I walked a few blocks until weariness overwhelmed me and I climbed on the first passing cable car. Afternoon shifts had just ended and jostling sweaty men crowded the car, some already smelling of whiskey and beer. “What happened, dearie?” one asked, his ruddy face pushed toward mine, a blunt finger tracing his cheek. “Cut yourself shaving?” Laughter poured from every mouth. Open as it was, the car breathed heat. Head pounding, I leaned out into the cool.

“Miss Vitale!” cried a voice and I was reined back, strong hands grasping my arms. “Give the lady a seat, you oafs.” There was a shuffle and I sank into an open slot between looming shoulders. “It’s me, Niko Pappas,” said a voice above me. “You stitched my arm, remember? Do you live on Geary Street? Can I take you home?”

“Geary?” I repeated dully. “This is the Geary line?”

“You wanted another one?” The red-topped face came closer, blocking the cool as two arms, one bandaged, corralled me in the rattling car. “Are you lost, miss?”
Are you lost? May I help you?

“Get back! Don’t touch me! You’re no policeman!” I shouted. Voices ceased around us and the wide brow furrowed.

“I’m a carpenter. I told you.”

But this too could be a lie. The car was slowing for a stop. With a shove I pushed free of the grasping arms and jumped onto the street. The car rattled away with a tear of voice thrown back: “Miss Vitale, wait!” As fog wrapped the car I saw a dark figure leap from it.

“Van Ness?” I demanded of a passing woman and followed the point of her gloved finger, running block after block, then leaning, gasping, against the boardinghouse door. I remember my key rattling in the hole, my feet catching the threshold, the parlor swirling, a little sleep and then Molly’s face over mine, angry.

“What’s wrong with you? Two decent women were scared out of their wits by you crashing in like that, jabbering away. Now they’ll never board here, ever. A man talks to you on a cable car, offers to bring you home and you lose your mind?” She leaned closer, rough hands grasping mine. “Irma, you have to stop being such a peasant.”

“I’m sorry, Molly. I lost you—tenants—” The work of speech was too much. I sank back in the horsehair settee and closed my eyes against hot hammers. A hand pressed my forehead.

“Why, you’re sick, lass, you’re burning up and here I’m railing at you! It’s bed you need, come.”

Molly must have sent for Dr. Bucknell, for later I heard her voice in the darkened room, then Mrs. Sullivan’s: “If it’s typhoid, she must go to the dispensary.”

And Molly: “With all the sailors and riffraff? I can do for her right here, good as any doctor.”

My eyes closed to Dr. Bucknell’s voice, her words floating across the bed: “no space in the dispensary . . . too sick to move.”

So I could die far from home, like Francesca. “With the best of care, half will die,” Dr. Bucknell had said.
Half will die
. The words spun in my head. Feverish and exhausted, I struggled to dodge them.

A scuffle of voices, a door closed and footsteps clattered away as Dr. Bucknell spoke of clean and dark, quinine, purges, calomel, Madeira, pea soup and opium. I slept, woke, and then was neither asleep nor awake, but swirling on burning waves, sliding down flaming walls that frayed into fingers grasping at me. Then I was hollow, purged, cold wet cloths draping my skin. Strong hands, a flash of dry white, the crisp comfort of ironed sheets and then tossed on burning waves again.

“She has to be bled,” Mrs. Sullivan was saying. “Feel the pulse, it’s too strong.”

A man’s voice protested in a voice I almost knew.

“Are you a doctor?”

“No.”

“A relative of Miss Vitale?”

“Nobody’s bleeding nobody,” a third voice said sharply, surely Molly’s. There was a scuffle of words, heavy footsteps clicking away and then there were two in the room, Molly and a dark, tall shadow moving at her direction. Darkness brought fever, always higher. “Step fever with fever, evening onset,” I vaguely remembered from lessons, until words themselves boiled away and every kindly figure faded. Others took their place: my father pulling me to the looking glass as I tried to pull away, caught in an altar cloth, twisted in lace and tangled in fringe. I struggled to beat free. Now hands wrestled me still, like a sheep for shearing. My bed that was soft turned hard as brick, wet and cold. Thieves fell upon me, plucking. Blank faces laughed. Then the stink of wet ash and Jake, the false policeman, pushing, pulling, thrusting, grunting, hissing, “Working girl, greenhorn, filly bitch.”

“No!” I screamed. “Let me go.” A spoon forced between my teeth brought the sweet tang of opium. At first the faceless crowd still hovered, pointing at my scar, snarling, then slowly it melted into mist, leaving me as thin as a stick stretched on bobbing sea grass. Jacob floated by with Attilio, smiling and waving as I eased away to sleep.

Days and nights passed. Voices came, hands moved and washed me. Slowly the pain in the gut retreated. Once a hard nut was pushed between my lips and a deep voice whispered, “Irma, swallow this.”

Molly’s voice flared in the room, “What’s that, you crazy Greek?”

“Olive pit. It’s good for the stomach.” Two voices, rising, falling and then fading away, laughing.

That day or the next I began taking broth, then bits of bread in broth. “The fever’s stepping down,” said Molly. “You had us worried, me and the lad.”

“What lad?”