1
NASHVILLE, TENNESSEE, 1941
Say, Horstmann, want to meet a jerk?”
The voice seeped into the melee in which Dorothy, a modern-day Gulliver, was being roped down by tiny little men. Apparently, she’d stumbled into the little guys’ mysterious world, and they were hopping mad.
She peeled open an eye. In front of the cardboard boxes in the storeroom where the residents liked to steal a nap, a baby-faced redheaded man was peering down the front of his white gown at her. Probably not a dream. Barry Montgomery was a resident at Vanderbilt, same as she. But she wasn’t sure. She’d slept thirty minutes over the last forty-eight hours—not uncommon these past ten months at Vandy—and her senses couldn’t be trusted.
She shut her stinging eye. “Do I?”
“Oh, I think you’ll want to meet this one, if the nurses are any indication.”
Over the radio that Dorothy forgot she’d turned on, the sound of clacking typewriters announced the end of orchestral music and the start of a news program. She pushed herself upright and snapped off the receiver.
“Don’t you want to hear the news?” Barry had a newborn baby and two kids, but with his carroty cowlick and ruddy cheeks, he looked like he should be carrying a slingshot and harmonica in his pocket, not tongue depressors and an otoscope. He was thirty, a year older than she was—did she look so young? “What country do you think the Germans are invading today?”
Even half-asleep, unease slithered into her gut. On another side of the planet, horrible things were happening, yet they were carrying on here in the States as if this were not so. This was not sustainable. “Are there any more countries in Europe left for them to occupy?”
“Russia.” Barry’s stethoscope bounced against his white gown as he pulled her to her feet. “Upsy daisy! Come get a look at this character—if you can see him through the wall of panting nurses.”
“I can’t believe I’m giving up precious sleep for this.”
“Yeah, yeah. You can thank me later.”
Her dream hadn’t quite left her as Barry prodded her down the hall. It must have come from studying Group A streptococcus under a microscope earlier. What robust lives bacteria lived! When they found themselves in a favorable new situation, like a plate of blood agar, the happy little hedonists rejoiced at their good luck and threw themselves into a frenzy of feasting, after which they procreated, then procreated some more, until there was nothing left to squeeze out of life and then they died. She was almost fond of the tiny terrors, so bold, so hungry, so hell-bent on having it all. She would have been fond of them, had they not claimed millions of human lives.
An ominous mechanical whoooooossshhh-GROAN, whoooooossshhh-GROAN broke into her thoughts. Behind the windows of the polio ward, nurses could be seen rushing between toddlers crying in their cribs and kids laid out in full-body casts. Other nurses tended to the source of the metallic moaning, the ventilators containing individual children.
In medical school, Dorothy had asked, once, to be put into an “iron lung,” to see how it felt. A tall teenage patient had just graduated to a cuirass respirator, the kind that fits on the patient’s chest, and had vacated his extra-long chamber model. Two nurses hesitantly agreed to Dorothy’s request, glancing at each other when she laid herself down on a gurney.
“Transfer me in!” she’d said. A crinolined lady taking a picnic to watch the first battle of the Civil War could have been no more jovial.
The nurses wheeled her next to the ventilator and, in a real-life Gulliver’s Travels situation, heaved her up from the stretcher and dropped her onto a cushioned tray. They then slid the tray into the tank and closed the coffin-like lid, latching it shut with just her head jutting out.
“Ready!”
Someone turned it on. With a clank and a groan, the machine wound up. Pressure bore down on Dorothy’s chest as if an elephant had sat on it. Then, after every scrap of breath was flattened out of her, the elephant got up; a tsunami of oxygen rushed in. She was drowning in air when the elephant plumped down again, vacuuming it out of her.
She pounded the sides of the tank. From somewhere in her lungs, she scraped together the wind to gasp. “Help!”
The nurse—Dorothy still remembered her name, Trudy—put her face inches from Dorothy’s, her breath smelling of the Wrigley’s tucked between teeth and cheek. “Go along with it. Let go. Let the machine do the work.”
“I can’t!”
Dorothy felt a hand grab hers—Trudy had reached into one of the portholes. “Yes, you can.”
Humiliatingly near tears, Dorothy let the device squeeze the air from her lungs then release them to fill. She breathed, not on her terms, not comfortably, not naturally, not happily, but she breathed.
Even now, that fear still felt fresh as she scanned the row of machines, the mirror positioned over the end of each reflecting the terror, bewilderment, or resignation of the child within. Her job as a doctor was to fix these broken kids. Worse, they actually thought she could.
Barry plucked at her arm. “Come on, Horstmann. You’re not going to beat polio today.”
“What if I do someday?”
He laughed. “Sure you will. And I’m finding the Fountain of Youth.”
Down the corridor, a crowd had formed at the nurses’ station. The man in the center didn’t seem much older than she was. He was almost comically handsome, with a matinee idol’s dark hair oiled in waves and a dapper mustache. He even had a Laurence Olivier–like cleft in his chin. Judging from his expensive pin-striped suit, he could have actually been a celebrity, or else he came from money. Most people in her profession had money in their background, at least they did at the upper-echelon medical schools. Women were scarce in a place such as this; women from families like hers, even scarcer. In fact, she had so far yet to meet another person like herself in her field. She was the human equivalent of a unicorn.
Barry addressed him over the nurses. “Doctor, I’d like you to meet somebody.”
The nurses, seeing that a physician was speaking, even if only a resident, cleared a path for Barry.
“Excuse me.” Dorothy tried to get through, too, but the nurses were not conditioned to falling aside for a woman. “Sorry. Sorry.” She squeezed a nurse’s arm in apology after knocking into her, then held out her hand to Young Dr. Suave. “I’m Dorothy Horstmann. Nice to meet you.”
He stopped talking long enough for his gaze to travel the considerable distance up and down her doctor’s gown. She braced herself. Go ahead. Say it.
He put out his hand. “Dr. Horstmann, nice to meet you. Albert Sabin. This is my colleague”—he ushered forward the young man next to him—“Robbie Ward.”
Dr. Ward, as big-boned and brawny as a football player, pulled back his chin to gawk at her. “You are tall!”
Ah, there it was. Somehow, seeing a six-foot-one woman pressed a lever in most people’s brains, and those three words instantly shot out. It was uncanny.
He shook his head in appreciation. “You are a lot of blonde.”
She supposed the bird’s nest atop her head qualified her as a blonde. She smiled for Dr. Ward, not wanting him to be embarrassed should he realize how idiotic he sounded, then turned to Dr. Sabin. “Aren’t you the one who advised doctors not to perform tonsillectomies in the summer because of their connection to polio?”
He bowed. “I am.”
“How old were you when you wrote that paper?” Barry asked. “Ten?”
“Twenty-six,” Dr. Sabin said. “But even a ten-year-old could have suspected that performing surgery in polio season might be a bad idea.” He crooked a corner of his mouth. “More often than not, the obvious is true, yet we ignore it.”
Oh, yes. He was that Dr. Sabin, the boy wonder. She’d heard about him when she was fighting her way through medical school back in San Francisco. While he was in medical school, he’d devised a test that doctors around the world still used to more quickly identify the type of bacteria causing pneumonia. Word was that he’d been offered the chance to head up pediatric research at the University of Cincinnati, a minor research institution until he’d arrived there. Many colleagues were said to be rubbed wrong by his cocksureness, irritated by his belief that he was leaps ahead of every other living being in his thinking, but Dorothy didn’t see how that made him any different than most other medical men.
Now he started down the hall as if he were a chief showing off his hospital and not a young visiting doctor. Dorothy and the others followed three abreast, with Dr. Ward eyeing her as he walked next to her, as if to measure who was the taller.
“What brings you to our humble clinic?” Barry asked Dr. Sabin.
Dorothy detected sarcasm. There was nothing humble about Vanderbilt. People liked to think of the university as the Harvard of the South. Some newly minted MDs chose to do residencies at the hospital simply for its prestige, Barry among them. While she could certainly use the prestige, Dorothy chose Vandy because, well, it took her. Even that had been an error. Dr. Morgan had forgotten that Dr. D. M. Horstmann was a woman when he’d accepted her based on her record. He still hadn’t figured out how to get rid of her.
Robbie Ward answered for Dr. Sabin. “Top secret.”
“Not really,” said Dr. Sabin. “I’ve been given permission by the NIH to conduct autopsies on every polio victim within four hundred miles of Cincinnati. You had a seven-year-old boy die here this morning, so here I am.”
Dorothy glanced away, a shard of grief shivving the inside of her sternum. The child had been admitted for weakness in the arms and lower extremities. Within two hours, his paralysis had progressed so quickly that they didn’t have time to get him into an iron lung to breathe. He died as Dorothy was desperately puncturing an opening into his windpipe. She’d tried to resuscitate him for twelve minutes after the attending physician had pronounced him dead. The attending had sent her from the room, telling her to “get hold of herself,” which was how she had ended up in the lab, numbly watching the antics of the deadly microscopic strivers.
“Did you have to come all the way to Tennessee for a body?” Barry said. “Don’t you have enough in Ohio?”
Dr. Sabin lifted his Olivier cleft. “Evidently, I don’t.”
“It’s a four-hour trip here,” said Barry.
“Three-and-a-half,” Dr. Sabin corrected, “when Robbie’s at the wheel of his convertible. If he ever tires of medicine, he could be a race car driver in du Mans.” He pronounced it the French way, Dorothy noticed. A man of the world.
Robbie ran his hand through the peninsula of sandy hair left by his receding hairline. “Aw, I don’t drive so fast. Though it is true that my wife refuses to go out with me if the top’s down.”
“Just be glad you’re not on the back of his motorcycle in February,” said Dr. Sabin.
“Say!” Robbie exclaimed. “It wasn’t my idea to take the Harley to that case!”
“I assume full responsibility.” To Dorothy, Dr. Sabin said, “Do you know the secret of staying warm on a motorcycle ride in February?”
She made herself smile. The chest-beating got tiresome.
“Newspapers!” Dr. Sabin replied to his own question. “You stuff your coat with them. Friend Robbie taught me. They’re excellent insulation.”
“I’d like to try that,” Barry said.
“No, you don’t!” Dr. Sabin exclaimed over his shoulder. “We looked like Tweedledee and Tweedledum.”
“I meant ride a motorcycle.”
“Easy as riding a bicycle,” said Dr. Ward. “You just—”
Dorothy spoke up. “Why are you doing so many autopsies?”
The men looked at her, their boys’ club talk interrupted.
“You’re zipping around the country doing postmortems on patients who weren’t yours—why?” She smiled. Always smile. Always disarm. “I can think of pleasanter reasons for a road trip.”
Dr. Ward glanced around as if a spy might be hiding behind the drinking fountain. “We’re working on something big. When we’re done—”
A look from Dr. Sabin snuffed his colleague’s speech.
“May I sit in?” said Dorothy.
“On the autopsy?” Dr. Ward exclaimed. “You want to sit in on an autopsy?”
“It wouldn’t be my first.” It wasn’t that she enjoyed postmortems, although she preferred them to injecting mice with pathogens, for instance. An autopsy subject could no longer suffer; a mouse could. But since she hadn’t been able to save the boy, she felt she owed it to him to find out what went wrong. Anything to help to get closer to the day when she didn’t have to tell a mother that she’d lost her baby to polio.
Dr. Sabin shrugged. “I don’t see why you shouldn’t attend. You’ll have company.”
2
Dorothy peered through the window of the gallery. It was going to be a most peculiar autopsy. Not only was it to be performed in a surgical operating theater instead of in the morgue, but Dr. Sabin had brought his own instruments—medical bags full of them. Now masked, gowned, and gloved as if his subject were still alive, he reviewed his paraphernalia. Dozens each of scalpels, saws, scissors, and forceps were arrayed before him like the keys of a pipe organ that he was about to play. At his side, Robbie, the maestro’s assistant, prepared stacks of slides and rows of vials. The body had not yet been brought in.
Down the row from Dorothy, the chief of medicine, Dr. Morgan (still recovering from allowing a woman on his staff), narrowed eyes deep within bony sockets. “This is ridiculous.”
The nine other doctors in attendance agreed.
He leaned forward to speak into the microphone, the light of an overhead bulb reflecting off his rocky slab of brow. “Why the elaborate production, Dr. Sabin?”
Dr. Sabin glared up through the bright lights of the operating theater, visibly irritated at being held up by the arrival of the body. “Since we are experiencing a delay, allow me to provide some background. As you know, our esteemed colleague Simon Flexner tells us that the poliovirus enters the body through the olfactory neuronal pathway and spreads directly from there to the central nervous system.”
“Yes, we know,” said Dr. Morgan. “You can lower your mask so that we can hear you—you can’t infect the body once it comes.”
A few of the doctors chuckled.
Down on the operating floor, Dr. Sabin either didn’t hear or pretended not to. “And since Dr. Flexner says this, what does the scientific community do? Chases ways to stop it from entering the nose. Installing nasal plugs, putting powdered zinc or picric acid up the noses of children—none of this works, or worse. Some of the children permanently lost their sense of smell. Our colleagues seem to have forgotten Hippocrates: ‘First, do no harm.’ ”
“It’s not forgetting Hippocrates,” a doctor declared, “when you’re trying to save a child!”
Dr. Sabin waited for the gallery to settle down. “Meanwhile, more children perish from polio. Yet no one asks, is it possible that Flexner’s conclusions were based on flawed work?”
“But why should we think that?” Dr. Morgan exclaimed into the microphone. “Simon Flexner is the leading authority on polio.”
Dr. Sabin cocked his head with a little smile. “If something is not working, shouldn’t you ask yourself why?”
Behind the glass, the doctors grumbled. Next to Dorothy, Barry said, “Who does he think he is?”
Dr. Sabin scowled at the operating room door before continuing. “First of all, Flexner’s conclusion that poliovirus enters through the nose was based on research using rhesus monkeys. What if they process poliovirus differently than other kinds of monkeys, or, more importantly, humans? I’m already finding this to be so—what is true for the rhesus is not necessarily true for us.
“Second, I realized that the autopsists in his studies were using dirty scalpels, with no care to sterility. The patients were already deceased, I suppose they figured, so what did it matter? But you see, it does matter. If poliovirus on a scalpel contaminated otherwise unaffected tissue samples, the wrong inference could be made.” He surveyed the row of doctors. “Same goes for contamination by an autopsist not wearing a mask.”
“Do you think you might have polio?” Dr. Morgan scoffed.
“Have we proven that is impossible? Gentlemen, when it comes to polio, we have proven essentially nothing.” He paced now, his irritation growing. “Flexner’s work was sloppy, but we didn’t question it, because Flexner was the top man. All those years, wasted, because of an early wrong turn.”
The chief leaned into the microphone. “How do you know that they were wasted?”
“Where is the body?” Dr. Sabin burst out. “Robbie! Go find it!”
Robbie trotted off.
Begrudgingly, Dr. Sabin returned his attention to the gallery above him and, scowling, took down his mask. “So far, in all of the sterile retrieval procedures that Dr. Ward and I have conducted, we’ve found that poliovirus in the nasal olfactory bulb is nonexistent. It’s just not there.”
“So you are saying that Simon Flexner was wrong,” said Dr. Morgan.
“In a nutshell—yes.”
“But how does the virus get to the nervous system to cause paralysis? What’s the path?”
“Here’s the interesting thing.” Dr. Sabin paused as if reluctant to share this information. “The poliovirus may not be readily found in the digestive tissue of rhesus monkeys, but it is found in humans.”
Dorothy sat back. It didn’t make sense. Polio was a disease of the nervous system, paralyzing its victims, sometimes to the point that they couldn’t breathe, like the poor child who they would be autopsying. Already other scientists were reporting finding the poliovirus in human stools. Was he saying the virus didn’t just pass through the digestive system but grew in it? How’d it get there? How did it paralyze kids from there?
Robbie pushed into the operating room. “There’s been a holdup on the release of the body.”
Dr. Sabin flung up his hands. “That can’t be. I have all the paperwork.”
“The mother is refusing.”
“Does she not know that this is for the benefit of science?” he exclaimed, as if that were everyone’s main motivation in life.
“There are some nurses talking to her, but they can’t bring her around.”
“Do something!” he cried.
His ideas burned through Dorothy like a gulp of whiskey. To pull herself away now was painful, but someone had to help.
She made her way past trousered legs. “Excuse me. Excuse me.” Dr. Morgan stepped aside, frowning, as she adjusted the chrome head of the microphone upward. Her voice twanged across the air: “Dr. Sabin.”
He shaded his eyes. “Dr. Horstmann?”
“I know her. I know the mother. I can try to talk to her.”
“Yes,” said Dorothy’s attending physician. “Yes, let Dorothy go.”
Dr. Morgan waved her off. “Go. This is no place for a woman.”
—
Dorothy sat in the waiting room next to the patient’s mother, a young woman whose delicate arms and wrists seemed to belong to a different species next to Dorothy’s hardy Viking bones.
“Mrs. Brooks, I’m very sorry about your son Richard.”
The woman lifted her face. Tender purple bags had swollen the woman’s eyes into slits. “I remember you. You were the one who came out and told me he was gone.” The words floated between them: You were the one who lost him.
“Is Mr. Brooks here?”
The woman plucked at the wilted flounces at her throat. “There is no Mr. Brooks. He died of a bleeding ulcer last year.”
Dorothy had only meant that she didn’t want the woman to be alone, and now she was making it worse. “Is there anyone who can be with you?”
“My sister Carolyn. But I sent her to find a lawyer.” The woman swung her head back and forth on the thin stalk of her neck, her soft brown ringlets rolling along with it. “I know I signed papers, but I changed my mind. I can’t do this to Richie.” She swallowed audibly. “I’m his mother. Doesn’t that count?”
“Yes. It does. Completely.”
The mother stared at the snapshot in her hands. “I know you want him for research.”
“Yes. To help others.”
Mrs. Brooks’s face crumpled upon itself. “Can’t you just use a monkey?”
“They say that the study of man is best studied in man.” Dorothy sighed. “I fear that is true.”
Mrs. Brooks lowered the photo to her lap. “He had a temperature over 101 and was throwing up. He said he just wanted to go to bed. His legs and arms felt funny—he couldn’t make them work right—but he just wanted to go to bed.” She balled her fists, pinching the photo under her thumbs. “I wanted to take him to the hospital, but he begged me not to. He was scared of the hospital. That’s where his dad died.”
“I’m so sorry.”
“I told Richie, okay, get some sleep. We’ll see how you feel in the morning.” She raised her face. “I killed him by waiting.”
“You were doing your best.”
“But it wasn’t good enough!”
Nor was Dorothy’s treatment of her son. Between her and this poor mother, the room was so thick with guilt that you could cut it into blocks.
“Do you have a child?” asked Mrs. Brooks.
Their eyes met.
“No. I wish I did.” Dorothy had never told a soul that. She rarely admitted it to herself.
Mrs. Brooks touched the serrated edge of the photo. “Whenever there’s been something difficult for me to do, I tell myself, you birthed a baby, Milly. If you survived the agony of giving birth, you can do anything.”
Dorothy had delivered enough babies in her obstetric rotation to nod solemnly.
Mrs. Brooks saw that Dorothy knew what she meant. “But childbirth only lasts for hours. This— This is never going to end. What do I tell myself now? How am I going to keep living?”
Dorothy wouldn’t look away. This woman deserved the truth. “I don’t know. But you will.”
They sat, the woman’s suffering filling the empty waiting room.
Mrs. Brooks looked up from the snapshot. “Letting the doctors have him will help others?”
Dorothy nodded. “Yes.”
“Then take my baby. Somebody’s got to do something about this terrible disease.” The woman lowered her gaze back to the photo.
Dr. Sabin wasn’t the only hero.
—
That evening, nursing a cup of scorched coffee in the diner across the street from the hospital, Dorothy waited as Barry fished another sugar cube from the bowl. The restaurant, hazy with tobacco smoke and steam coming from the cooking hamburgers, was filled with young associate professors with pipes and buckled briefcases, glassy-eyed medical students, and cigarette-smoking graduates with their shirtsleeves rolled up. Other than the two waitresses in white caps and aprons, and a nurse at a table with a doctor, Dorothy was the only woman in the place.
“I’m not sure what Sabin and Ward are up to, other than to attract attention.” Barry splashed the cube into his cup and stirred. “Does it really matter how the poliovirus gets to the nervous system? What counts is how we treat it once it’s there.”
Dorothy glanced over the rim of her own cup. It mattered a lot. To beat polio, you needed to snuff out the virus in the body before it attacked the nervous system—it would help if you knew where in the body you were supposed to do the snuffing. ...
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