Orphan #8 (9 page)

Except for trips to the toilet and a weekly bath, the children in the Pertussis Ward were confined to their cribs; even meals were delivered to them there. When Rachel had been brought here at the end of May after recovering from the measles, she
was so exhausted all she could do was lie limp, her eyes, still sore from conjunctivitis, half-closed. Occasionally the coughing would start up, so violent she could hardly catch her breath, until finally she retched and collapsed in relief. All that long summer, as flies buzzed through the open windows of the ward, the whooping cough had come and gone. Eventually, though, as the nights became cooler, the paroxysms came less frequently until finally they had ceased.

As Helen Berman updated Rachel’s chart, she saw that the Rabinowitz girl had turned five last month. Counting back from today’s September date, Helen noted there hadn’t been an episode of whooping cough for weeks. As she finished notating the chart, she decided this one could finally be transferred into the Infant Home itself, where she would join the other girls in kindergarten. Five months in the hospital wing was more than enough for any child.

Rachel hoisted herself over the iron bars of the crib and landed on her bare feet. She crept past the other children who were napping or staring into space or muttering to themselves until she reached the book cart. She wanted to pick a book she’d never seen before, but to do that she had to look at each one, carefully turning the pages. As soon as she recognized a picture, she dropped that book on the pile accumulating in her lap and reached for another. She was absorbed in her task when the ward door opened. Rachel was surprised to see the big nurse with red hands, the one who had taken her clothes and cut her hair back on that first day. Rachel tugged at her hair, long enough now to cover her ears, and hoped she wouldn’t be seen behind the cart.

“There you are!” Nurse Shapiro dashed into the nurses’ station,
startling Helen. “Dr. Hess is on his way here. He’s giving the new resident doctor a tour of all the wards. I wanted to warn you that . . . wait, where is that child?” Nurse Shapiro pulled Helen into the ward and pointed to the empty crib. Turning frantically, she spotted Rachel crouched behind the book cart.

“Are you in the habit of letting them run loose?” Nurse Shapiro’s chapped hand closed on Rachel’s arm, hoisting her up, but the books in her lap tipped her forward and she fell, hard, on her knee. “Oh, for goodness sakes,” Nurse Shapiro muttered, picking Rachel up and carrying her over to the crib.

“Believe me, I never let them out unattended,” Helen stammered. “This one is very sneaky.” She shook Rachel’s shoulder. “What have I said about climbing out of your crib?” What she had said was not to bother her just to use the toilet, but Rachel was too confused to answer.

“Listen,” Nurse Shapiro said. “I came to tell you—” The ward door opened again. She and Helen turned as Dr. Hess stepped into the room, guiding a young woman whose dark hair was pulled back in a severe bun. A member of the Ladies Committee, Helen assumed, though the woman’s jacket and skirt were exceptionally plain, nor was she wearing a hat.

“Ah, Nurse Berman,” Dr. Hess said. “I’d like you to meet Doctor Solomon, our new resident in radiology.”

Helen blinked, puzzled, and looked over Dr. Hess’s shoulder for this new resident. Beside him, the young woman cleared her throat and extended her hand. The nurse was grasping the woman’s fingers before she put it together. “Oh,
you’re
Doctor Solomon.” She offered a friendly smile that was met with a withering stare. Helen instantly formed the opinion that this woman doctor
was unattractive, though there was nothing particularly offensive about her features—except, perhaps, her beaked nose. As the doctors brushed past them Nurse Shapiro whispered, “I tried to warn you,” before slipping out of the ward.

Ignoring the nurses, Dr. Hess continued his conversation with Mildred Solomon. “Now, as I was saying, I’ve been skeptical of these new pertussis vaccines. As you well know, the whooping cough comes and goes over the course of months. What may seem like a cure one week could simply prove to be a temporary cessation of the symptoms. Only by comparing a number of subjects over the entire course of the disease can we begin to develop reliable results. What was needed was a controlled experiment. So, for the past hundred days that’s precisely what we’ve done.” Dr. Hess waved his arm across the room, taking in the cribs and the children in them. “I enrolled nine of the children as material for the study. Three were vaccinated before being introduced to the ward, three were vaccinated at the first evidence of whooping cough, and three were never vaccinated at all. I’ve just completed my assessment, and as I suspected, the current vaccination is ineffective.”

“Dr. Hess, I cannot tell you how impressed I am by the opportunities for research the institutional setting affords.” Doctor Solomon’s voice, though pleasant in pitch, was not melodious. She made an effort to keep her tone flat, countering the natural tendency of her voice to rise at the end of each statement.

“I’ve always maintained,” Dr. Hess said, “that the questions being asked in modern pediatric medicine cannot be answered by experiments on animals but must be decided by clinical observations on infants. The ability we have here to control conditions is
unparalleled. Nutrition, sunlight, activity, exposure to disease—everything can be controlled and measured. This has proven invaluable for my work on the causes and cures of scurvy. In my study of rickets, however, some unanswered questions remain. For instance, I had hoped to establish whether, if Negro infants were deprived entirely of sunlight, they would develop rickets to the same degree as white infants placed in similar conditions. Without the cooperation of my counterpart at the Negro orphanage, however, such an experiment has proven to be impractical.”

“Still, Dr. Hess, your use of X-rays in the diagnosis of rickets was a tremendous innovation.” When it came to conversing with distinguished physicians, one lesson from medical school Mildred Solomon had taken to heart was the strategic deployment of flattery.

“That’s true, yes. We routinely x-ray every child coming into the institution, as soon as they are cleared of disease, of course.”

Dr. Solomon nodded. “The radiography facilities here at the Infant Home are renowned.” She might have added they were the reason she’d applied for the residency, but she knew people preferred to believe it was some feminine affinity for the care of children.

“There I must credit our donors for their generosity in building and equipping this hospital wing.” Dr. Hess tilted his head in a studied gesture of humility, assuming his connection to the Straus fortune was common knowledge. “Not only do we have a modern X-ray room, but our laboratory is also fully equipped for microscopic tests, throat cultures, and blood work.”

“I am eager to see the X-ray room,” Dr. Solomon said, turning slightly to indicate her readiness to continue their tour.

“Excuse me, Dr. Hess.” Helen had been standing beside them, unnoticed, a chart in her hands. “I was wondering if you would sign off on this child? Since your study has concluded, and she appears to be fully recovered, I thought perhaps she could be released from the Pertussis Ward?” Helen wouldn’t usually display such pluck, but after Nurse Shapiro’s disapproval, she was anxious to rid herself of the troublesome girl.

Dr. Hess took the chart, frowning at the interruption, his pen poised over the paper. His experienced eye took note of a decline in the child’s weight. “Which one is this?”

“Right here,” Helen said, leading them to Rachel’s crib. Dr. Hess glanced down and was struck by the girl’s pallor. Rachel, recognizing his egg-shaped face from her first terrifying day at the Home, cringed. “As long as we’re here, Dr. Solomon,” he said, handing the chart back to the nurse, “would you allow me to demonstrate my method for diagnosis of latent scurvy?”

Mildred Solomon offered a look of professional interest, masking her impatience. “Of course, Dr. Hess.”

“If a child presents with the acute symptoms—loss of teeth, bleeding in the mouth, redness of the gums—there is no question as to the diagnosis. Just last week at the city hospital where I conduct a clinic, a child was admitted with scurvy that had advanced to necrosis of the gum tissue. I can tell you, the odor was extremely unpleasant. In such cases the only course of action is immediate treatment with the established cure of orange juice by mouth. With the latent cases, however, there is opportunity for experimentation, knowing that at any time the progression of the disease can be reversed. Recently, for example, I’ve been attempting intravenous injections of citrated blood.”

“That sounds promising,” Dr. Solomon offered, though it seemed to her a ridiculous idea.

“The results so far are not encouraging.” Dr. Hess looked thoughtfully at Rachel. “See here, Dr. Solomon, the pale skin, the peculiarly alert and worried expression? I have found these to be symptomatic.” He reached for Rachel, who scampered away from the sudden movement with a cry. “Sometimes in cases of latent scurvy, I find as we approach a child’s bed, it whimpers or cries out in terror. Typically, though, it lies quietly on its back with one thigh everted and flexed on the abdomen. Nurse?”

“Yes?” Helen stepped forward.

“Have you noticed this one in such a posture?”

Unsure of what she was being asked, she answered, “I suppose so, at times?”

Dr. Hess harrumphed. “Further examination will show if one or even both thighs are swollen and exquisitely tender, or if there is merely tenderness.” Dr. Hess squeezed Rachel’s leg, pressing the spot where she had fallen on her knee. She cried out. “Ah, you see? Finally, we palpate the ribs for beading.” His fingers dug into her sides, squeezing the breath from her lungs. “This is where the X-ray has proven most valuable, for the beading, which is apparent in the radiograph, is not always discernible through palpation.”

Rachel, released from his grip, retreated to a corner of her crib, panting.

“You can perform your first X-ray on this one, Dr. Solomon. If, in the radiograph, you see beading on the ribs or the characteristic separation of the shoulder, I’ll enroll it in my scurvy study.”

Dr. Solomon leaned over the crib, her elbows balanced on the metal bar. Her thoughtful gaze landed on Rachel, though she was
thinking not of the little girl but of her own ambitions. Still, the steadiness of her eyes gave Rachel a feeling she hadn’t known in months: the sensation of being noticed. Rachel thought the lady looking at her was very pretty. She liked how her dark hair and brown eyes brought out the pink in her cheeks. The loose bow tied around her neck swung over the crib; Rachel reached up and tugged at it. Dr. Solomon, excited at the prospect of finally getting her hands on the Home’s excellent X-ray equipment, allowed herself to be amused by the girl’s antics. After all the discouragement, the competition, the sniping from the other medical students, she, Mildred Solomon, had gotten the coveted residency in radiology, and here, tugging at her necktie, was her first subject. A smile swept across her face, too swift to be stopped. The little girl smiled back. It seemed a good omen. Dr. Solomon straightened up, composed her features, and made her pitch.

“Dr. Hess, knowing of your interest in childhood nutrition and digestion, I wonder if you’ve considered supplementing your use of gastric tubes with barium X-rays?” Dr. Solomon lifted Rachel’s chin with her hand, stretching out the throat. “I recently saw a demonstration of the barium swallow using a fluoroscope—the images were stunning—but wouldn’t it be interesting to chart the entire digestive tract? With a group of subjects of similar size and weight, we would soon develop a basic understanding of normal rates of digestion that could be useful for comparison in cases of blockage or other complaints.”

Dr. Hess considered the idea. “Does the barium remain reflective throughout the entire tract?”

“For the lower intestines, an enema is called for, but yes.”

“It’s a very interesting idea, Dr. Solomon, one well worth pursuing.
If the X-ray is negative for scurvy, why not use this one for your first barium series? Either way, let’s transfer her to the Scurvy Ward.”

Dr. Hess nodded to Helen Berman, who made a note on Rachel’s chart. She was sorry the child wouldn’t be joining the others in kindergarten but glad the troublesome girl would, at least, be out of her ward.

R
ADIOGRAPH SHOWS NO
evidence of scurvy
. Mildred Solomon made the note on Rachel’s chart with a sense of satisfaction. Now the girl would be hers for the initial series of barium X-rays. If she could impress Dr. Hess with this study, Dr. Solomon hoped she’d get approval for an experiment of her own design, though she hadn’t decided yet what she would propose. Eager to get started, she gave the nurse in charge of the Scurvy Ward instructions that the Rabinowitz girl was to have no food whatsoever for the next twenty-four hours.

“Not even a little milk? She’s sure to cry.”

“No, only water, nothing else. It’s very important for the quality of the radiograph.”

“Yes, ma’am,” the nurse said, then corrected herself. “Yes, Doctor.”

Mildred Solomon made no effort to hide her irritation at the subtle insubordination. The nurses never questioned Dr. Hess’s orders the way they did hers. Simply because they were all women was no reason for the nurses to assume they were on the same level. Perhaps once they saw her taking charge of a study, they would begin to show her the deference a doctor deserved.

The next day, Dr. Solomon alerted the technician to ready the X-ray room while she prepared the barium drink, mixing the powder thoroughly in cold water. Entering the Scurvy Ward, she approached Rachel’s crib, a large metal cup in her hand. “You must be very hungry,” she said.

Rachel looked up at the pretty doctor. All of the nurses had been so mean to her, leaving her in the crib while the other children ate, ignoring her crying as her stomach cramped and growled. “I’m so hungry. Did I do something bad? Is that why they won’t give me any food?”

“No, you haven’t been bad. In fact, you’re doing something very important for science.” The girl looked at her quizzically. “Very important for
me
,” she said, and saw Rachel’s face soften. Dr. Solomon hoped the nurses could hear how kindly she talked to the child. She demanded their respect, yes, but she wouldn’t mind if they liked her—she had endured enough hostility in medical school. “I brought you this milk shake. I want you to drink the whole cup, and then we’ll go to the X-ray room again, like we did a few days ago. That didn’t hurt a bit, did it?”