"Wait! I didn't get your name."
"Oh, sorry. Ella Moskowitz," the woman said, extending her hand.
India took it. "Dr. Jones," she said. "You're the receptionist?"
"And the nurse, secretary, clerk, and bookkeeper. Zookeeper, too. I can't stay to chat. We're way behind. Going to have to go at it hammer and tongs to get you through that lot by lunchtime."
"What? All of them? By noon?" There were more people in the waiting room than she could see in an entire day, never mind a morning.
"Yes, all of them."
"Is Dr. Gifford here?"
"No. It's just yourself today."
"My word. Is there some kind of epidemic?"
Ella Moskowitz burst into laughter. "Epidemic! That's a good one. Oh, it's an epidemic, all right, it's Whitechapelitis. This is just a normal day. You want to see true pandemonium, wait till there really is an epidemic. Got zol ophiten!"
"I beg your pardon?"
"Sorry. God forbid. You're not Jewish, are you?" she asked. "Can't imag-ine you are. Don't recall a lot of Selwyn Joneses at temple. Many of your patients are, though. Any trouble with the Jews, call me. Any trouble with the Irish, you're on your own."
Ella hurried off, leaving India to stare after her. She barely had time to orient herself before Ella was back with a patient--a small, thin woman whom India guessed to be in her mid-forties. "This is Mrs. Adams, and this is her file," Ella said, slapping a folder on the desk.
"Wait one bleedin' minute!" Mrs. Adams cried.
Ella stopped in the doorway. "Yes, Mrs. Adams?"
"I'm payin' good money to see a doctor and I want to see a doctor, not a flippin' nurse."
"Dr. Jones is a doctor, Mrs. Adams."
Mrs. Adams looked at India. "Pull the other one, it's got bells on," she said.
India looked down at herself, at the too-long jacket, the rolled sleeves, and realized that she looked like a child playing dress-up.
"Now, Mrs. Adams--" Ella began.
"It's all right, Ella," India said, closing her office door. "Good morning, Mrs. Adams. I assure you I am a doctor. I have a diploma. Would you like to see it?" She reached into her bag and took the document out.
She had other things in her bag, too. Colorful illustrations of smiling fruits and vegetables. Booklets on economical and nutritious cookery. Pamphlets on the principles of proper hygiene. She planned to share them with her patients during examinations.
Mrs. Adams gave the diploma a look but remained unconvinced. "You have one of them things Dr. Gifford wears? Round his neck?" she asked.
India pulled her stethoscope out of her bag and held it up.
"All right, then. I reckon you'd have to be a doctor to have one of them."
India smiled. "Can you tell me what's troubling you?"
"Baby's paining me something terrible. Dr. Gifford gave me laudanum and it helped for a while, but not no more."
"Do you have the bottle with you? May I see it?"
Mrs. Adams reached into her dress pocket for the bottle and handed it to India.
She read the label. It was laudanum, all right, which was not usually prescribed for pregnant women. "How long have you been taking this, Mrs. Adams?" she asked.
"About three months."
"And how far along are you?"
"Five months. Maybe six."
India nodded. She scanned Mrs. Adams's file, but saw no mention of pregnancy. She did see Dr. Gifford's notations for pain and fatigue, and that he'd started her on a weak laudanum solution and had been increasing the strength of the dosage. She led Mrs. Adams into the exam room and persuaded her to remove her dress and lie down on the table. Mrs. Adams wondered aloud why it was necessary and said Dr. Gifford never made her, but did as she was asked. When India saw her bare arms, she had to work to keep her expression neutral. Mrs. Adams's bones were practically pro-truding through her skin.
"Are you eating well?" she asked.
"I haven't much of an appetite. Been feeling a bit green, but that's to be expected with babies."
"Nausea is very common," India agreed.
"You don't have to tell me. Nine pregnancies I've had, and five living chil-dren. None was easy, but this one's the hardest. I'm that tired, there's days I fall asleep standing up. Once by the stove. Nearly set me pinny on fire."
"How are you sleeping at night?"
"Poorly. Pains me to sleep on me side, and I can't get comfortable on me back."
"How old are you, Mrs. Adams?"
"Forty-six. Never thought I'd quicken again at this age. Thought it was the change because me periods stopped. But then there was quite a bit of bleeding right before, y'see, and there's no bleeding with the change, is there?"
"May I look at your belly?"
Mrs. Adams nodded. India undid the buttons of her camisole and the tie at the waistband of her petticoat to expose her abdomen. She saw im-mediately that instead of the pleasing, symmetrical swell of pregnancy, there was an uneven, lumpy look to her belly. Starting just under the ribcage, she pressed down into the muscle, feeling for the fundus, the top of an expanding uterus, but could not find it. Her hands moved lower, probing for a bony nub--a skull, heel, or elbow. Nothing. She fished in her bag for her fetal stethoscope, a wooden device that resembled a bicycle horn. She pressed the bulb end to Mrs. Adams's belly and put her ear to the trumpet-shaped cup. Again, nothing. There was something growing inside Mrs. Adams, of this India was certain. But it was not--and had never been--a baby.
"Is everything all right? There's nothing wrong, is there?"
India dodged the question. "Do you know what a speculum is?"
The woman shook her head.
"It's a device that enables doctors to view the reproductive organs. I would like to take a look if I may."
Mrs. Adams opened her mouth and stuck out her tongue.
"Um ...no, Mrs. Adams. It's the other end I need to examine."
"You what?"
"I need to do a vaginal exam. I can't tell what's going on inside you un-less I look inside you."
Mrs. Adams sat up. "Why, you filthy little monkey! I've never heard of such a thing in all my born days. Is that what they teach you in medical school? To use dirty words and look up people's privates?" India heard anger in the woman's voice, but in her eyes there was only fear. "Why can't you just give me my prescription like Dr. Gifford does?" she asked, her voice rising.
"Now, now, now. What's all this noise, Mrs. Adams?"
India started and turned around. A compact man with gray hair and a neat goatee stood by the desk. It was Dr. Gifford. He hadn't bothered to knock; he'd simply walked into the exam room, not knowing who was inside it or what was occurring. India found it highly discourteous to both herself and her patient.
"Oh, Dr. Gifford, I am glad to see you! This lass of yours has me stripped to me drawers when all I want is me prescription filled."
"Dr. Gifford, there is no gravidity," India said, choosing language she hoped her patient could not follow. "There's a uterine mass. A large one..."
"That will be all, Dr. Jones."
"But, sir, Mrs. Adams should be examined internally. She should--"
"That will be all."
"What's she on about, Dr. Gifford? Is me baby all right?" Mrs. Adams asked anxiously.
"Everything's fine, Mrs. Adams." He scribbled on a piece of paper and handed it to her.
"Here's a new prescription. Three drops every two hours in your tea."
Mrs. Adams's drawn face shone with relief. She thanked Dr. Gifford, dressed hurriedly, and left.
"Dr. Gifford..." India began.
"You are far too slow, Dr. Jones," Gifford said briskly, noting the prescription in Mrs. Adams's file. "Ninety percent of the time you should simply perform a quick exam and prescribe laudanum."
"That woman probably has uterine cancer. She needs surgery, not laudanum."
"I'm afraid surgery is not possible in Mrs. Adams's case."
"You... you knew she wasn't preg
nant?"
Dr. Gifford looked up. "Yes, I knew. Do you take me for an idiot?"
"Of course not. I didn't mean to imply anything of the sort. But ...why didn't you tell her?"
"To what end? She's going to die, whether I tell her or I don't. Why make her last months harder than they have to be? Let her think she's pregnant. What harm is there in it? And keep her out of pain. More I cannot do."
India could not believe what she was hearing. Gifford was making an outrageous set of assumptions. He was playing God. Elizabeth Adams was a grown woman, not a child. She deserved to be told the truth and allowed to make her own decisions.
"Dr. Gifford, the tumor may be operable," India said. "Or benign. If I could persuade her to allow a vaginal examination, I could take some cells. Make a slide. See if by some chance it is benign and if her pain is caused by the pressure it's exerting."
Dr. Gifford put his pen down. His expression was thunderous. "Dr. Jones, you are a new doctor, and inexperienced, so I will make allowances for you... up to a point. In case it has escaped your notice, this is an exceedingly poor area. The patients who come to this practice barely have money for treatment, never mind surgery. Even if Elizabeth Adams could afford surgery, she would not survive it. She's weak and malnourished. We are overwhelmed here, and must put our resources where they will be rewarded."
India swallowed hard. This particular issue hadn't been covered in her ethics class. "I'm sorry, sir. This is not the medicine I was taught," she said.
"It's the medicine you must learn," Dr. Gifford said. "This is not a text-book, Dr. Jones, this is reality. Elizabeth Adams is a lost cause, but the peo-ple waiting downstairs may not be. That is, if you deign to examine them before the turn of the next century." He closed Mrs. Adams's file and stood. "No more than ten minutes a patient, Doctor. Good day."
"You're leaving, sir?"
"Is that a problem?"
"No, sir."
"I have patients to visit at London Hospital. I merely stopped in on my way to see how you're getting on. Not well, from what I've witnessed. I hope I have not made a mistake."
"You have not, sir."
"I would hate to disappoint your dean. Good day, Dr. Jones."
"Good day, sir."
India put her head in her hands. What a terrible beginning. She could not lose her position. The mere thought of explaining to Dean Garrett An-derson that Gifford sacked her because she hadn't been up to the demands of the job was unbearable. As she sat fretting, a snatch of the dean's graduation address came back to her: The eyes of the world are on you now. Many will applaud your every triumph. Many more, your every failure....
India had heard the words people used against herself and other medical women--immoral, indecent, unsexed. She'd felt the ugliness behind them, and she knew she must never give Dr. Gifford any reason to regret his decision to hire her. She must not fail.
She remembered how every quarter, the same few lines appeared in the school's magazine at the dean's behest: "Medical women are earnestly requested to send notice of any appointments they obtain, or any vacant ap-pointments they know of, to the secretary of the Medical School." There were so few appointments obtained by medical women, so few available to them. India knew that if she lost this one, she wouldn't find another. But what Dr. Gifford had done--lying to a patient about her condition--was unconscionable. She didn't have long to dwell on her dilemma, however, as Ella was already leading another patient into the office--a little boy accompanied by his mother.
"Henry Atkins," she announced. "Worms."
After young Henry there was Ava Briggs, a sixteen-year-old girl with a severely infected jaw. Her mother had had all her teeth pulled two days ago. By a blacksmith. "As a birthday present," she explained. "No man'll marry a girl with her own teeth. Costs him a fortune in dentist bills." After Miss Briggs there was Rachael Eisenberg, married a whole month and still not pregnant. And Anna Maloney, who thought she was seventy but couldn't really remember and had been constipated for two weeks. Fifteen more followed, and then at noon, just when India thought she would surely drop, Ella bustled in with a teapot and hamper.
"Bring anything to eat?" she asked. India shook her head. "Didn't think so. We'll share mine. Lucky for you I keep an extra plate around."
"Oh, I couldn't, Sister Moskowitz."
"It's Ella..."
India bristled at her informality.
"... and you'd better. I don't have time to pick you up off the floor when you faint from hunger."
India forced a smile. Something was gnawing at her, but it wasn't hunger. She'd put aside her misgivings about Dr. Gifford earlier to concen-trate on her patients, but could ignore them no longer.
"Roast chicken," Ella said, placing half a bird on the desk, "parsleyed potatoes, and kasha." She frowned, dug deeper, then brightened. "And noodle kugel!" She handed India a plate and fork. "Tuck in."
"There's enough for ten here. Did you cook all this yourself?"
"My mum did. My parents have a caff on Brick Lane. Kosher food."
India speared a potato with her fork. She was still standing up.
"Sit. Eat. Rest. You'll need your strength for this afternoon," Ella ad-vised.
India sat. She picked at her potatoes some more, then put her fork down.
"Is something wrong?" Ella asked.
India told her about her contretemps with Dr. Gifford.
"Yes... so?" Ella said, between bites of chicken.
"So? So how can I possibly continue to work here? To do so would be to condone the worst sort of medicine."
"Don't you even think of leaving," Ella warned.
"But how can I stay? I understand the need for expediency and practi-cality in a busy surgery--of course I do--but this isn't a question of ef?-ciency. It's a question of ethics. Of morality."
Ella laughed. "Oh dear. Brought your morals with you, did you, Dr. Jones?
To Whitechapel? That was a mistake. Tomorrow, leave those little buggers home."
India did not laugh. She glared. "What Dr. Gifford did is indefensible. He should have informed Elizabeth Adams of her true condition, explained her prognosis, offered her a choice of treatment, including no treatment if that's what she wanted. But the choice should have been hers. Not his."
Ella stopped eating. She stopped joking. "Dr. Jones, why did you take this job?" she asked.
"To help the poor."
"Then help them."
"But Dr. Gifford--"
"Shit on Dr. Gifford."
India sat back in her chair, shocked. "What a thing to say! You work for him."
"No. He pays me, that's all. I work for them," she said, hooking her thumb in the direction of the waiting room. "There are two dozen people downstairs. Poor people. Sick people. A lot of them are kids. Put your qualms and quibbles aside and help them. That's all the morality you need. All right, Dr. Jones?"
India didn't reply at first. Then she said, "It's India."
Ella smiled. She put another piece of chicken on her plate before clearing up. "Sneak a few bites between patients if you can. I'll send the next one in."
India never touched the food. She drove herself mercilessly all after-noon and into the evening, seeing children with rattling chests, a docker's wife whose husband had cut off her finger during a fight, laundresses who could barely move because of wrecked backs, girls with scurvy, a prostitute with syphilis, a boy who'd been attacked by a bull terrier, several children with dysentery, two toddlers burned in their hearths, a tubercular baby, and a little boy who'd swallowed a sixpence--and whose mother wanted it back. She was just finishing with her last patient, a factory worker with a swollen liver, when the clock struck the hour--seven p.m.
"I'm giving you a prescription for liver pills," she told the woman. "And I want you to abstain from alcohol."
"How's that?"
"No more drinking. No whisky, porter, ale... none of it."
The woman looked at her as if she were mad. "I'd sooner give up breathing." r />
"You will if your liver gets much worse," India replied.
The woman laughed merrily and took her leave. Not one ounce of self-control, India thought, watching her go. Working-class people astonished her. They had so little, and yet they spent their hard-earned wages on alcohol, sweets, and unnourishing foods they called relishes--trotters, bacon, pickles, and such. Like Mrs. Burns, the woman who had the tubercular baby. The little girl had been thin and pale and gumming a brandy snap.