The Anatomy of Deception (42 page)

She refused.

“You don’t love me, Ephraim. You are fond of me, I know, and I think that you would be kind and generous to Samuel. But I’ve struggled too arduously to accept a proposal from a man who would have chosen another. Also, my work here in Philadelphia is far too important to me.”

My choice of Abigail over this exceptional woman was yet another of my mistakes that would have no remedy.

In the end, I put as much distance as I could between myself and Philadelphia, settling in the small but growing city of Seattle, Washington. Physicians were scarce and I was welcomed without question. There, I courted and married a lovely woman. She was not mercurial and intoxicating like Abigail Benedict, nor formidable and determined like Mary Simpson, but she is kind, gentle, and accepting of my faults. We have been married forty-one years, and have three sons,
two daughters, eleven grandchildren, and, as of last year, a great-grandson. I will retire as a physician this year—my eyes and my hearing are not what they were—but the children’s hospital I helped found, the most progressive institution of its kind in the West, I am proud to say, will continue here under the guidance of others.

With age, I have come increasingly to gaze at progress from afar. Air travel astounds me. While my scientist’s mind can accept Bernoulli’s principle in theory, I will never consent to sit inside a metal tube shooting through the clouds with nothing to keep it from hurtling to earth except forward motion. My son George, however, flies often, and my grandson Ephraim, all of sixteen, insists that he will be a pilot. I am more sanguine about earthbound conveyance and love my Nash.

I followed Dr. Osler’s remarkable life almost to obsession. He took his position at Johns Hopkins and was so instrumental in altering the manner in which physicians viewed their work that his life could be considered the fulcrum upon which the science of medicine pivoted. During the next decade, he completed his textbook,
Principles and Practice of Medicine
, which is still the standard by which all similar works are judged. In 1892, Dr. Osler was named president of the American Pediatric Society. He has received honors and awards sufficient to fill a volume of their own.

In 1905, he left Johns Hopkins to accept the Regius Professorship of Medicine at Oxford University, the most prestigious medical appointment in the English-speaking world. At Oxford, although it seems impossible, his achievements were even greater than those in America. In 1911, he was knighted by the king, Edward VII.

Dr. Osler did indeed marry the widowed Mrs. Gross, and the couple had one son, Edward Revere. When young Lieutenant Osler was killed in Flanders in 1917, it broke the Professor’s heart. He died a mere two years later. He did, in fact, order a
postmortem on himself and his prediction of what would be found—thoracic empyema, pus in the right pleural cavity, a massive pleural infection—turned out to be exactly correct.

In addition to his professional achievements, Dr. Osler amassed one of the most astounding personal libraries in the world, over eight thousand volumes, the majority devoted to the history of science and medicine, including the most exhaustive collection of material on Servetus ever compiled. He spoke of Servetus often, even using him as the subject of his annual address to the Johns Hopkins student body, and he was among the benefactors of a monument that was erected in Annemasse, France, just across the border from Geneva, where Servetus had been burned at the stake.

William Stewart Halsted remained at Johns Hopkins for the rest of his life. Although always a brilliant surgeon and teacher, he was responsible for few surgical innovations after the early 1890s. Perhaps morphia had sapped his genius. Still, it is fair to say that every great surgeon of the first three decades of this century has walked in Halsted’s footsteps. He married Caroline Hampton, the nurse who had been the inspiration for his invention of surgical gloves, and they lived something of a reclusive life together. Although there is no evidence in either direction, I suspect he remained addicted for the rest of his days. In one of medicine’s great ironies, Halsted died in 1922 after complications from the same gallstone surgery that he had invented forty years earlier to cure his mother. Two of his former students performed the operation.

After Dr. Osler left for England in 1905, Mary Elizabeth Garrett, Hopkins’ major benefactor, commissioned a group portrait of Osler, Halsted, Welch, and the gynecologist Howard Kelly, to be called “The Four Doctors.” For this task, she engaged not Thomas Eakins, but the expatriate American John Singer Sargent. Only Dr. Osler lived in London, where Sargent’s studio was located, so the other three crossed the
Atlantic to sit. During the process, Sargent found Halsted so unpleasant and overbearing that he was rumored to have painted his image so that it would fade over time.

Neither Abigail Benedict nor her brother ever returned to America. Albert died in a traffic accident, run down by a carriage in Zagreb in 1892. The driver was never apprehended. After her father’s return to America later that year, Abigail lived in London for a time, then in Florence. In 1895, she married a French count twenty years her senior. The couple, childless, spent much of their time traveling about in Europe and Asia. When Abigail’s husband died of esophageal cancer, Abigail retired to his ancestral home near Avignon, where she lived as a recluse until her own death last year. As far as I could learn, she never exhibited any paintings. I was saddened at her death, but more at what seemed to be a lonely and unfulfilled life.

Thomas Eakins remained at his home on Mount Vernon Street until he died there in 1916. Although the Pre-Raphaelites he despised slipped from public acclaim, Impressionists did not. Art continued to retreat from realism and, with the rise of abstractionists like Picasso, Eakins saw his reputation wane even further. After the Lachtmann affair, Eakins devoted himself almost entirely to portraiture. He could not hide his bitterness, however, and his subjects were almost always rendered in an unflattering light, often as much older than they were. In desperation, he even attempted to incorporate some of the modernists’ techniques into his later paintings, but was nonetheless no more than a footnote in American art at his death. Susan Eakins still lives in Philadelphia, an indefatigable champion of her husband’s work. Whatever Eakins’ faults, I can only hope that one day his great talent will finally be appreciated by a nation that has spurned him.

Mary Simpson never married. The Croskey Street Settlement House thrived and became the model for similar institutions. During a speaking engagement in 1912, Mary was approached by a woman who claimed to admire her work greatly, and sought to create even more progressive enterprises for
women. That woman’s name was Margaret Sanger. I corresponded with Mary from time to time, and I hoped that we would always think of each other as friends. She died peacefully of congestive heart failure four years ago, surrounded by friends and admirers. I can only hope that when it is my time, I will be so fortunate.

Haggens, despite both his style of life and his heart condition, lived for another twenty years, although Mike was shot to death in front of The Fatted Calf not six months after I left Philadelphia. Sergeant Borst was indeed promoted, eventually to captain, and he was a mainstay of the Philadelphia police department until his retirement in 1915. As far as I know, he still lives in the city. Jonas Lachtmann returned to California, where he had gotten his start, just after the turn of the century. I was more than a bit anxious when I learned that we lived in such proximity, but Lachtmann was never the same man after 1889, and he preferred to ignore me than revisit the tragedy of his daughter’s death.

I kept Abigail’s portrait of me, not as a reminder of the man I wished to be, but rather of the sins of pride and arrogance that I wished never to repeat. I dedicated my life to atoning for my role in the death of George Farnshaw although, for quite a while, despite my wife’s assurances, I felt that I never would. Then, ten years ago, at Christmas dinner, I looked around at my family, and walked into the study to read a testimonial from the grateful citizens of Seattle that I had mounted on the wall. I considered the sum of my life, went to the attic, fetched the portrait, and threw it into the fire.

My life would have been very different, I know, had I accepted the Professor’s offer and accompanied him to Johns Hopkins. I would, as Dr. Osler predicted, have achieved wealth and fame; more importantly, I would have undoubtedly contributed, as he did, to the saving of thousands of lives. But among the many decisions of my life I might wish to rescind, that is one that I have never regretted. For in turning my back on the many, I believe that I saved myself.

T
O ADDRESS THE MOST IMPORTANT
point first:
The Anatomy of Deception
is a work of
fiction
. There is not a scintilla of historical evidence to suggest that William Halsted ever committed murder. Nor is there any indication that he ever performed an abortion, although, in the thousands upon thousands of surgeries he did perform, many of them private, it is not impossible that he terminated a pregnancy or two. As to his continued drug addiction, however, and thus his susceptibility to blackmail, extremely persuasive evidence does exist, and it emanated from the unlikeliest of sources.

For the last thirty years of Dr. Halsted’s life, and for almost half a century after his death in 1922, it was assumed by the public, his students, virtually all of his colleagues, and certainly his patients that he overcame his drug dependency in the 1880s by sheer force of will. The three extant Halsted biographies, none of them scholarly (the last of which, provocatively titled
Cocaine, Cancer, and Courage
, was published in 1960), were written by friends, colleagues, or offspring of colleagues. Each extols the man for the indomitable will required to perform such a feat of self-control.

Then, in 1969, a manuscript Dr. Osler had written but instructed be kept sealed until fifty years after his death was finally opened. In this account, called
The Inner History of the Johns Hopkins Hospital
, Dr. Osler revealed that Dr. Halsted had remained a drug addict. The great surgeon continued to inject morphine—regularly and in large doses—during
Osler’s entire career in Baltimore. (Osler left for Great Britain in 1905, but one can reasonably assume that after two decades of addiction, Halsted did not choose to go through withdrawal in his fifties.) Thus the many operations that Dr. Halsted performed—for which he indeed was sometimes paid more than $10,000—were completed while under the influence of opiates. According to the manuscript, only Osler himself knew of Halsted’s ongoing drug use, although Michael Bliss, an Osler biographer, stated Welch possibly knew as well.

The failure to speak out about Halsted was not the only incident in which Dr. Osler turned a blind eye to the malfeasance of a fellow physician. He also remained silent after an incident in Montréal in which a patient died as a result of a colleague’s obvious blunder. Dr. Osler reassured the other doctor that no one would remember the incident in six months.

The disclosure that, whether for altruistic motives or not, Dr. Osler would keep such secrets gave me the idea for this novel. From my research, I have no doubt that William Osler personally epitomized the very peak of medical ethics and was a man of exceptionally high moral fiber. Had he paid a price, I wondered, for ignoring the immoral acts of others in pursuit of the advancement of medicine and the betterment of mankind? Would he have reported Dr. Halsted to the police if Halsted had committed a crime under the influence of drugs?

The larger question, of course, is whether science must inevitably be willing to compromise ethics in order to achieve great and beneficial change. Medicine in 1889 was a science teetering on the edge of immense advances in curing disease and alleviating suffering. I believe we as a society are in a similar position today. Dr. Osler’s dilemma could easily be our own.

From a narrative standpoint, I strove to portray the personalities of both men as they were. Osler was affable and well liked, while Halsted, after his addiction, became sarcastic and
aloof. (Despite the rumors, Halsted’s face in the Sargent portrait did not fade over time.)

I thought it crucial to get the science right, and thus all of the medical tradecraft depicted in
The Anatomy of Deception
is as historically accurate as I could make it, from the instruments used to the order of procedures. The autopsies conducted by Osler in the first chapter come from his own notes; the manner in which he examined patients in the ward and the discussion of a physician’s four compass points also come from life.

For dramatic flow, I did take minor liberties with chronology. Rubber gloves, for example, while first fabricated in 1889, were evidently not used by a surgeon until 1890. William Osler often had tea at the home of Samuel W. Gross before Dr. Gross’ illness, and thus was introduced to Grace Linzee Gross before she became a widow.

The art side of
The Anatomy of Deception
is also, I hope, substantially correct. Thomas Eakins did teach in Philadelphia, where he had a nervous breakdown, and was sent out West to recover by Weir Mitchell, who was at the time considered the preeminent authority on nervous diseases. Eakins remains one of the great controversial figures in American art, and he did pose frontally nude for his own photographs. His reputation plummeted with the rise of abstract art, but he was eventually rediscovered and is now considered one of the great painters in our history. His medical paintings and their impact are as described.

Once again, for smoothness, I made some changes. Eakins, for instance, did not convert the top floor of the house on Mount Vernon Street to a studio until after his father’s death in 1899. From 1884 until that year, he worked out of a rented studio on Chestnut Street.

While Reverend Squires and the Philadelphia League Against Human Vivisection are fictional, there was great resistance to autopsy in 1889, and all the machinations necessary
to secure cadavers are as they were. The Blockley Dead House was as described, and the attendant was an Alsatian whom Osler nicknamed “Cadaverous Charlie,” who had indeed been caught on more than one occasion drinking from the specimen jars. There was an exhumation in which a corpse was discovered to have three livers. Although Wilberforce Burleigh is fictional, his surgical techniques are not. More surgical patients died of shock and blood loss than of illness in 1889. Cesarean section had a mortality rate of 80 percent.