The Heart Specialist (31 page)

About half an hour later the fire again began to dim and George rose to her feet. “You must have learned by now, Agnes, that it’s not possible to judge a life from the outside,” she said. Her voice had an edge. “One inevitably gets it wrong.” Miss Skerry’s face was half-turned from me and tinted by the firelight, making her expression difficult to read.

“I didn’t mean to criticize you,” I said. “Just the opposite.”

There was a long pause and when George spoke again her voice was gentler. “I’m happy here, Agnes. I have my pleasures.” She patted the worn cover of her book. “I am among people to whom I feel close.” Her voice wavered slightly. It might have been fatigue or smoke in her throat, or it might have been emotion.

23

AUGUST 1917

Afternoon light poured in through the window. It lit up the papers arranged on the floor around me. It spread over the table cluttered with jars and wax reconstructions, X-rays and charts. It coloured the skin of my hands and neck, and my forehead etched from hours of classifying. The heat was strong; I rocked back on my heels and leaned into the shade.

I stood to pull the blind and my knees almost buckled. While I worked I often forgot about my legs tucked beneath me. They felt dead. I propped my bottom on the rim of a lab stool and unbuttoned my collar. The little room on the top floor of the new Medical Arts Building was directly beneath the copper roof. It trapped the heat.

No one else was so obstinate as to work on campus through the months of July and August. Most of my colleagues were overseas, but even those who had remained in Montreal fled the city for the summer. Awful old Dr. Daimler, who had replaced Dr. Clarke as acting head of the medical faculty, hadn’t shown his beaky face all July. I should count my blessings, but the secretaries were gone too, which I regretted. I liked to visit them and chat on breaks. At the moment even the janitor, a man named Cook whom we all called “the King” because of his self-possessed airs, was on holiday. People would start returning in a week or two, although there was hardly any urgency. The incoming class was tiny. If the war dragged on much longer, which it gave every indication of doing, the medical faculty would be forced to let in women. Perhaps there had been something after all to Miss Skerry’s opinions.

I made it a point of honour to arrive at McGill each morning at eight o’clock and put in a full day’s work. It lent shape to my life. There was plenty to do. I had just completed a pamphlet on Florence Nightingale, who had died recently at the age of ninety. A publishing house in London had shown interest, especially after I suggested that all the proceeds could go to the Red Cross. I’d accepted an invitation from the New York Academy of Medicine to give a talk at the end of the month. In the United States I had become something of a celebrity. My fame had spread, I suspected, largely by default. There were few scientists left on Canadian soil and I stood out as one of a handful of people continuing to do original research.

The talk I had planned was ambitious, the culmination of my years of research. I had gathered the specimens I used in my teaching and for publications. I was planning something entirely new. The traditional reading of dusty reports no longer interested me. I wanted to shake my audience and make them sit up.

What I had fashioned was a travelling show about the heart, designed to appeal to the senses instead of merely the mind. I had material to fill eight sheets of grey millboard, occupying wallspace four feet by thirty-two feet high. Awkward for travel, but once I’d set up it would take the breath away.

Strewn at my feet were my treasures: a collection of Jakob Hertzlich’s sketches of cardiac anomalies, forty-two photographs of specimens, twenty-four radiographs, a number of tracings, seventeen charts and twice that number of diagrams. On the table were fifty specimens suspended in their jars, showing the most common defects and anomalies, as well as a handful of reptilian and piscine hearts to show the evolutionary and ontological course of development. In cases where I had no specimens I had made wax reconstructions.

Leaning against my desk was a chart of statistics indicating the special features of a thousand cases of congenital heart disease and necropsies. This material had originally been published in Howlett’s textbook and was the cornerstone of my fame. But now I would build further. I was not simply a researcher — “Howlett’s lackey” Jakob Hertzlich had once called me — compiling the results of his work in his shadow. Now I would step out on my own. I would do so in style.

Among the sheets scattered on the floor was a flyer announcing my talk.
Heart Specialist
, it read, giving my name and academic degrees. The advertisement would be published in major American newspapers on the eastern seaboard. Thousands of people would receive copies, one of whom might be my own missing father. Of course my name had changed, but surely he would recognize his wife’s maiden name and the Christian one he had given me. I had no idea where he was living. I had inquired about him at the medical schools in Canada and at the major ones in the United States, but without result. He had probably set up a practice in a small town in the Boston area, to which many French-Canadians had migrated. I believed he was still practising. Medicine had been his life.

Whenever I published an article or saw my name in print like this on the flyer I felt a surge of hope. Honoré Bourret might see it. It was my life’s dream.

On the table beside me were a collection of case studies, neatly typed and ordered. I would take my audience by the hand and lead them through the process of a diagnosis. Doctors were still astonishingly ignorant when it came to deciphering murmurs and trills. In my years of clinical practice and observation I had discovered that the path to understanding the heart lay in its sounds. Finer diagnostic tools would one day be developed, but right now the best I could do was listen. Of course the electrocardiogram was making headway. There was one at the Montreal General Hospital — but for the moment not a single doctor there knew how to use it. The human ear was still the best tool. If a person took the time to listen the heart would eventually offer up its secrets.

My first case study was a boy of six, admitted to hospital with a swelling in his neck. The swelling had had nothing to do with his heart — it turned out to be a tubercular node — but the instant I had placed my ear on his chest I had known. There were no outward signs. No clubbing of fingers, no tint of skin. His lung fields were clear and the blood pressure normal. But as soon as my stethoscope touched him it revealed the terrible verdict. The murmur was harsh, echoing against his narrow ribs. It reverberated over the entire pericardium and both scapulae. Upon his death two years later my diagnosis was confirmed. The hole in his ventricular septum was the size of a nickel.

The second case involved a girl of fourteen whose parents had consulted me. She had visible birth deformities: a bent spine and clubbing of one foot. Her early development had been normal but shortly before their consultation with me the parents had noticed that the girl’s lips turned blue when she ran or walked vigorously. She was a small child, underdeveloped for her age and still prepubescent. There was no generalized cyanosis, no clubbing of the fingers or difficulties with breath. Midchest, however, I heard the clicking and diagnosed her on the spot.

The nurses at the hospital called me a witch; little was known about the heart and my diagnoses seemed like sorcery to them. All I did was to look and to listen. What others called magic was the careful, practised use of my ears and eyes.

Once a diagnosis was made, of course, there was nothing I could do. Such was the problem with cardiac anomalies. Cures were nonexistent. My patients were doomed to short lives of pain. The boy with the ventricular septal defect had been eight years of age when he died. His heart was now bottled and shelved. In time, provided her family consented, I would take the girl’s.

I looked briefly up from my notes. I was surrounded by hearts, sectioned and preserved. Hearts with holes. Hearts with leaking valves or thickened walls. Hearts with narrow or transposed aortas. I closed my eyes.

When I opened them the dean’s secretary was standing in the doorway. Over the last few years I had come to know Mrs. Greaves more intimately. She was a widow whose husband had died years ago during the infancy of their only child, a red-haired boy named Alexander. Now Alexander was in Flanders. He had been part of the victory at Vimy Ridge in April. More recently he had fought at Messines. He was still alive. Apart from Alexander Mrs. Greaves had but one sister who was a nun. She was alone like me. And like me she had shown up for work every day of this hot summer. She had not, to my knowledge, indulged in one day of sick leave. Every time she received a letter from her boy she climbed the stairs to the museum to share it. Alexander didn’t write half as well as Dugald Rivers, but I rejoiced over his letters just the same, encouraging his mother to share the four or five scrawled lines with me over a cup of tea.

Today Mrs. Greaves was wearing a blue smock-like dress. Her face was puffy. “Mail’s arrived,” she announced, holding out a letter.

I made out foreign stamps and the looping script of Dugald Rivers. “Did you get one?” I asked, taking mine from her.

Mrs. Greaves shook her head.

I had not read Dugald’s letters aloud to Mrs. Greaves but the woman in the doorway looked so forlorn I decided I should. I checked the postmark. The third of July. It had taken over a month to reach me.

“Terrible, the waiting,” said Mrs. Greaves when I showed her. “Even when you get a letter you can’t be sure if they’re alive.”

I nodded. This was something I didn’t like to think about.

“My neighbour’s boy was at Ypres. Second battle,” Mrs. Greaves went on. “The Army sent a telegram informing her he’d been killed. Two weeks after that a letter arrived from him announcing his good health.” She paused. “It’s enough to do a person in.”

I put a hand on Mrs. Greaves’s shoulder. Before the war I would not have invited this woman for tea, let alone touched her. Now she was a friend. “Let’s see what dear old Dr. Rivers is up to,” I said, diverting my guest by unfolding the onion-skin sheets. The letter was long, written in a hand that seemed spikier than Dugald’s usual flowing script. At the moment, he wrote, he was in a hospital in London sleeping on an honest-to-God mattress between real cotton sheets, bathing in hot, clean water and eating food other than bully beef and wormy biscuits. That was the good news.

Mrs. Greaves’s jaw sagged. “Don’t tell me he’s been hit.”

He was intact, he wrote, but barely. His lungs were ruined. His battery had taken gas at Passchendaele, and that, combined with the interminable rain, had done him in. He’d suffered bouts of asthma so bad no one thought he would survive.

My own chest squeezed tight. For over a year Rivers had been divulging horrors so awful I had few remaining illusions about the sanity of war. He had described how German machine guns had mowed down battalion after battalion of Allied boys. The Canadian men had only rifles, and poor ones at that, with the fatal habit of jamming in damp weather. Our young men perished in rows, caught in the act of loading or cocking. In one unforgettable letter he described the gas used by the German Army. It hung over the trenches in a yellow cloud and shredded men’s lungs. It blinded as well, but its primary target was the lungs, which filled with pus. Gas victims died horrendously, drowning in their own secretions. In all his years of practice, wrote Dugald, he’d never seen anything so ghastly.

Few letters of this kind were reaching people back in Canada. Dugald was a particularly candid correspondent with an artist’s eye for detail. Although deeply patriotic and familiar with military culture he was a humanist before all else and the suffering to which men fighting on the Western Front were subjected appalled him. In the four years of the Boer War, he told me, a total of two hundred and twenty-four Canadians perished. The carnage of this current war was of a completely new order. Had his superiors ever suspected the contents of his letters I am certain he would have been censored. Fortunately for me he was clever enough not to give cause for suspicion. From the outside he appeared as quietly stoic as any other soldier.

He wrote that he himself had taken gas. His lungs had been weak to start with but now they barely functioned. He was able to hold a pen, which was encouraging, but I hoped he was not writing from his deathbed.

“Passchendaele,” I read aloud to Mrs. Greaves, “was like the Somme all over again. It rained relentlessly, turning the fields into a swamp. It was as if not only the men’s morale but the land itself had died. Everything was stripped bare. There were no longer trees or grasses or anything green, just mud rutted by shells, furrowed not for crops but for trenches.”

“The man’s a poet,” Mrs. Greaves said, dabbing her eyes. “I never would have guessed he wrote like that.” She uncrumpled her hanky and blew her nose.

As I read descriptions of men left to rot where they had fallen, prey to German bullets and shells, Mrs. Greaves became still. “Their flesh gradually drops away,” I read aloud. “They sit or stand in the trenches amidst the rest of the battle wreckage — steel helmets, rifles, the husks of bombs.”