Where the Light Enters: Excerpt 3

About this excerpt:  Elise is in medical school, on rotation at the New Amsterdam Charity Hospital; Sally Fontaine is a classmate and friend. Dr. McClure is the physician they are assigned to for the rotation.

Children's Ward, ca 1880

Children’s Ward, ca 1880

Early the next day Elise learned from Sally Fontaine that Tadeusz Kozlow had died in the night. It was not unexpected, and it was far from the first patient Elise had lost, but it was still a failure. She was thinking about him and wondering if the family had been told when Sally reminded her that they had to hurry if they didn’t want to be late for rounds.

“I’ve been thinking,” Sally said. “We just have to survive McClure until Monday, and I’ve got a plan.”

“A plan?”

“Today I’m going to stay out of her line of sight, and every time she looks in my direction, I’ll be writing furiously in my notebook. She doesn’t like it when you look her in the eye, have you noticed? So I won’t. That way I might just avoid the worst of her moods.”

When rounds were half over Elise decided the simplest plans were often best, because thus far she had been following Sally’s example, and both of them had been spared Dr. McClure’s temper. Just as that thought came into her head a nurse stepped into the hall with a swaddled, very quiet newborn on her arm.

Dr. McClure’s attention fixed on the infant. She asked a question Elise didn’t quite hear just as Sally whispered in her ear.

“Poor thing. Maybe the mother died.”

That was entirely possible. The mother might be dead or sick unto death; she might have refused to look at or acknowledge the child. But Sally had never been a nurse or worked in a charity hospital, and none of this was obvious to her. Now she pulled Elise away a little and asked for an explanation, one Elise gave to her in a few short sentences. And still, too many, because when she looked up, Dr. McClure was watching her.

“Miss Mercier,” she said. “Take this infant to the nursery and evaluate. Bring me your notes with a diagnosis, prognosis and treatment plan within the hour.”

Sally’s expression was contrite. Under her breath she whispered, “Oops. Sorry.”

“Never mind,” Elise said to her, and managed a small smile. “It could be worse. As you may soon find out.”


On her way to the nursery Elise studied the tiny face, as round and white as an underdone griddle cake, with eyelids of a bruised blue. In happier circumstances a newborn would be assigned to a wet nurse who would take her home. The city paid a small sum every week as compensation until the child died or reached six months of age. At that point it was sent on to one of the church-run asylums or in the worst case scenario, to the infant asylum on Randall’s Island.

If the Catholics claimed her, they would baptize her and name her for – whose feast day was it? St. Agnes of Montepulciano? St. Mary Clopas? Whatever name was she given, she would be fed and kept warm and clean and made aware of her humble origins. The nuns would teach her the Stations of the Cross and the catechism she would recite every day; she would learn to read and write and do sums, to sew and clean and cook and how to care for infants and linens. If she showed any inclination she would be groomed for the convent. Things would be much the same if one of the Protestant asylums took the baby in: a regimented but safe childhood. A warm place to sleep and a full belly was more than most orphans could count on in this city. Some met far worse fates.

As soon as Elise unwrapped the newborn in the nursery she knew that this little girl would never need a wet nurse or an asylum. It was not so much the low birth weight, but the way she breathed, snuffling through congested sinuses as though she had caught a head cold in the womb. Elise palpated her abdomen, and found what she feared: both liver and spleen were enlarged.

One of the student nurses had come close to watch Elise examine the baby. In a whisper she asked a question that took Elise by surprise.


Elise glanced at her. “Are you referring to the yellow cast of her skin?”

The student nodded.

“There are other reasons for the skin to take on such a color. Have you not studied the liver?”

An awareness came over the long, thin face. “Jaundice?”

“Yes. Even healthy newborns sometimes have jaundice. The liver is slow to begin its work. But in this case―”

Very gently Elise unfurled one clenched fist, and the student drew in a startled breath at the sight of watery blisters on the palms.

“How does a newborn get blisters?”

“They’re called bullae of pemphigus. A symptom of congenital syphilis. They will be on the bottom of her feet as well.”

The student was very young and new to medicine, and thus unable to hide her shock.

“There’s a chapter on congenital syphilis in the Prendergast text,” Elise told her. “It will be helpful to you.”

Because the girl asked thoughtful questions, Elise went on to point out other signs: the telltale coppery brown rash that covered the baby’s chin and vulva, and most significantly: her nose looked as though someone had pressed a finger to the bridge and flattened it.

“Sometimes the symptoms don’t show themselves for weeks or months,” Elise said. “This is an extreme case.”

The unnamed little girl began to twist and mewl and stutter a weak wail. Her heartbeat was less than steady, and her fontanel pulsed erratically. Worst of all, she had very little suck reflex. A newborn who wouldn’t suckle couldn’t live. It wouldn’t take an hour to write up the case for Dr. McClure; it would hardly take ten minutes, because there was nothing to be done.

A nurse Elise knew well came over and looked briefly at the baby. Margit Troy was highly skilled, compassionate and still pragmatic, exactly the right person to take responsibility for this infant. Elise should have been relieved to hand the little girl over to her, but she hesitated.

As was the case with the best nurses, Margit was very good at hearing what was not said: Elise wasn’t ready to give up the infant. So they worked together, bathing the baby and putting ointment on her rashes. They wrapped her hands and feet in loose layers of gauze saturated with more ointment, and swaddled her firmly.

The student nurse was desperate to be of help. “She’ll need feeding. Should I get a wet nurse?”

“No,” Elise said. “She is almost certainly contagious and it wouldn’t be right to risk the health of a wet nurse.”

In the end Elise sat down to see if the little girl would take a few ounces of warmed sugar water from a bottle with a rubber nipple, putting her cheek to a skull as fragile as porcelain. The baby swallowed feebly once, twice, and then began to cough, a startling sound from so small a creature.

Elise turned the little girl on her side and held her while the cough deepened. She caught the first sprays of blood with a towel and in no more than ten seconds, it was over.

Her shift was near its end by the time she finished writing out her notes and then the death certificate for Dr. McClure’s signature. Unnamed female newborn, Caucasian. As she had been taught to do, she left the cause of death blank, but attached another sheet of paper with proposed wording: pulmonary hemorrhage following from congenital syphilis.

There would be a price to pay not obeying Dr. McClure’s orders, but Elise found it hard to worry about that. In a few years she would probably have forgot whatever task Dr. McClure thought up, but for the rest of her life she would remember the first two patients assigned to her, because she had been unable to do anything for them, and both had died.

When the church bells at St. Mark’s in the Bowery tolled six o’clock Elise gathered her things. On her way down the stairs she could only hope not to come face to face with Dr. McClure. Instead she ran into Margery Inwood, who was almost as bad.

Margery was an able nurse but a terrible gossip. Working with her in the wards had meant constant dodging of inappropriate and intrusive questions about the Savards and their personal lives. Anna’s marriage to an Italian detective was an enduring topic of interest, or had been until the newspapers exploded with news of Sophie’s engagement to Cap Verhoeven. Margery had cut out headlines to show to Elise. Mulatto Doctress to Marry Dying Knickerbocker was the headline that had most tested Elise’s temper, but she had managed to remain calm.

“So,” Margery said now. “How are you liking medical school?”

“I like it,” Elise said, summoning a smile. “When I have time to sit and consider, I like it.”

“I’ve heard Dr. Morrison say that anybody who needs to sleep more than five hours a night should forget about studying medicine.”

“That just about fits my experience,” Elise admitted. “How are things with you?”

Margery ignored the question and leaned forward to put a warm, damp hand on Elise’s wrist.

“Tell me,” Margery said. “Is it true that Dr. Sophie came back to the city in order to start a medical school for negro girls?”

Elise pulled away in surprise. “Where did you hear that?”

“It’s common knowledge.”

“If that were the case you wouldn’t be asking me,” Elise said. “Really, Margery. You should know better. She isn’t starting a medical school. She’s setting up a scholarship fund.”

Margery wrinkled her nose in disagreement. “What I heard―”

The door that opened onto the ground floor opened. The man standing there was a stranger to Elise, but Margery Troy recognized him, because she paled at the sight of his unhappy expression. “Nurse Inwood, what is the delay?”

“Sorry, Dr. Martindale. I’m on my way.” And she took off up the stairs at a tear. Elise had never seen her move so fast.

Dr. Martindale, as she had called the man who still stood in the open doorway, stood watching her until she disappeared. Then his expression cleared and he shook his head, but his gaze was fixed on Elise. She saw curiosity there, but nothing of ill humor.

He said, “I think you must be Candidate Mercier. Don’t look so alarmed, it’s the color of your hair that gives you away.”

Elise’s thoughts jerked in one direction: who is talking about my hair? To another: who is this man?

Before she could think of something reasonable to say he was coming toward her, his hand outstretched. “Gib Martindale.”

He stood two full steps below her, and still Elise had to look up, just slightly, to meet his gaze as she shook the offered hand. He knew that he was being rude; he should have waited for her to make this gesture. But social niceties often gave way to more pressing considerations in medical settings.

“Elise Mercier. Somebody told you about my hair?”

He ducked his head, as if to draw her attention to his own thick mop, unfashionably short and almost exactly the same deep auburn as her own. “Actually, I asked. I caught sight of you on rounds – condolences, by the way, on being stuck with McClure – and I asked. You look so much like my wife, which is why I noticed you, but once I asked I got all the stories – good stories, complimentary. You needn’t worry.”

Elise drew in a breath. “That’s good to know. Thank you. I think.”

“Oh but it’s true,” he said. “You’re very highly valued for your—”

“Miss Mercier,” Nurse Troy called down the stairwell.

Elise turned and had to crane her neck to see up as far as the third floor “Yes?”

“Could you come back to the ward, please? We have an issue. I need your help.”

“It was a pleasure to meet you,” Elise said, which was true and not true; this Dr. Martindale had agitated her for no good reason except that he was friendly and complimentary and tall and – she glanced once more at him before turning to run up the stairs – very handsome. He was watching her with eyes that might have been grey or blue, his smile wide enough to show off a lot of very white teeth, with a chipped canine on his left.

He straightened and saluted her. “My pleasure entirely. Next time I hope we’ll be able to talk at more length.”


There were eleven newborns on the ward, and Elise had examined each of them before she left and made chart notes. On her way back up the stairs she went over the cases in her mind. Three might survive long enough to go home with a wet nurse. Five were simply too small and weak to live. The rest were the real challenge: a case of mild hydrocephaly, one of esophageal atresia, and one of severe spina bifida. What she might do for any of them was limited, but she considered the possibilities and then stopped short at the sight of a stranger standing in the nursery, as out of place in this ward as a bull.

He wore a sailor’s long pea-coat and stood legs splayed and tensed, as though he were on a pitching deck. Even if he had been dressed like a clerk or farm worker, anyone would recognize him as a sailor. His clubbed dark hair and beard were streaked with salt or sun, and his face and hands were deeply tanned.

“This is Mr. Bellegarde,” Nurse Troy said, unable to keep the unease out of her voice. “He is asking about his son, who was born here on the seventh of April, a week ago.”

“Can you tell me where to find my son?” His tone was curt to the point of accusation. “If you can’t, who can?”

Angry husbands and fathers were nothing out of the ordinary at the New Amsterdam, Elise reminded herself. Many of them had less cause than Mr. Bellegarde, whose name she remembered perfectly. His wife had been brought to the New Amsterdam by Sophie, on the day she returned to the city. And she had died of eclampsia a few minutes before her child was delivered.

He hadn’t asked about his wife, so he must know that much. She said, “Mr. Bellegarde, I can tell you that your son will have been sent home with a wet nurse, and he’ll be there still.”

“And the name and address of the wet nurse?”

“Let’s go to the records office, we can find out there.” His expression didn’t soften at all. Instead he made an abrupt sweeping motion with one arm, as though Elise were a child dawdling on her way to do her chores.

She set off, very aware of him right behind her.

end excerpt

Excerpt 1: Sophie’s letter home

Excerpt 2: Article from the New York Times regarding the Russo orphans