My Name Is Mary Sutter Part 1

My name is Mary Sutter.

Robin Oliveira.

For Drew, whose love and generosity never falter, and for my mother, who bequeathed me her muse.

Acknowledgments.

I am deeply grateful to my husband, Drew, my daughter, Noelle, and my son, Miles, for their forbearance and support during this book's evolution.

In addition, I am indebted to the stellar faculty of the Vermont College of Fine Arts MFA in Writing Program, with special grat.i.tude to Douglas Glover, David Jauss, and Xu Xi, whose uncompromising commitment to excellence fostered my ambitions. Program Director Louise Crowley and a.s.sistant Director Melissa Fisher (with a nostalgic nod to Katie Gustafson) infuse the entire community with a deep generosity of spirit. And to all the students (current and former) of that fine inst.i.tution, my deepest thanks for the joyous experience that is being an MFA candidate at VCFA.

I wish to thank Kaylie Jones, Mike Lennon, and Bonnie Culver, the judges of the 2007 James Jones First Novel Fellowship, for choosing my ma.n.u.script from the pile of outstanding applicants, and Christopher Busa of Provincetown Arts, who published a chapter of the novel in 2008.

Marly Rusoff, my extraordinary agent, and her partner, Michael Radulescu, brought enthusiasm, competence, and dedication to Mary Sutter. I am a very lucky writer to have found Marly, and in turn to have been found by her. My editors, Kathryn Court and Alexis Washam, are insightful women whose eagle eyes and critical ac.u.men drove me deeper into the story, helping me find its best and truest incarnation. The whole team at Viking has been kind and supportive.

Liesl Wilke, my dear friend, read the final ma.n.u.script and helped me unsnarl some very reluctant sentences. My husband, a physician, tutored me on the finer points of childbirth. Dennis and Kathy Hogan spent a week one winter driving me around the greater D.C. area visiting Civil War sites and museums. In addition, Domenic Stansberry read my final ma.n.u.script and made several helpful suggestions. For their words of encouragement, I also wish to thank Andre Dubus III and Wally Lamb. And finally, to Douglas Glover, an enduring and heartfelt thank-you for the gift of the question that guided me home.

People have asked me about the amount and type of research I conducted. What follows is a brief and by no means comprehensive account of an effort that spanned several years and myriad inst.i.tutions and was gleaned from books, Web sites, historians, libraries, museums, and various primary doc.u.ments, including newspapers, journals, government publications, lectures, and diaries. Most important, I delved into the records of the National Archives for the original doc.u.ments from the Union Hotel Hospital. The Library of Congress proved invaluable for Dorothea Dix's letters and the records of the Sanitary Commission's visit to Fort Albany. The New York Public Library also provided me with additional information about the Sanitary Commission. The Interlibrary Loan of the King County Library hunted down book after book and untold amounts of microfilm reels for me. The Special Collections at the University of Washington Medical School Library holds a plethora of books on medicine and midwifery that I plundered. I made heavy use of the New York Times's online archives. I would also like to note the Son of the South Web site for posting issues of the magazine Harper's Weekly.

A number of researchers steered me toward some invaluable discoveries. I am especially grateful to the online librarian at the Library of Congress who directed me to Clara Barton's War Lecture, which provided firsthand doc.u.mentation of the aftermath of the Second Battle of Bull Run and South Mountain. I hope Miss Barton won't mind that occasionally I used her specific details; they captured the peril under which the men and women at Fairfax Station and South Mountain were working, particularly her fear of the candles' catching the hay on fire and her conversation with a surgeon who intimated that triage occurred after the battle. The inimitable Miss Barton also was at Antietam, but there we parted ways. I relied mostly on my imagination and on Too Afraid to Cry: Maryland Civilians in the Antietam Campaign by Kathleen Ernst.

Other books of great help were Civil War Medicine by C. Keith Wilbur, M.D.; all volumes of the Pictorial Encyclopedia of Civil War Medical Instruments and Equipment by Dr. Gordon Dammann; A Vast Sea of Misery: A History and Guide to the Union and Confederate Field Hospitals at Gettysburg, July 1-November 20, 1863 by Gregory A. Coco; Gotham: A History of New York City to 1898 by Edwin G. Burrows and Mike Wallace; Mr. Lincoln's City by Richard M. Lee; Loudonville: Traveling the Loudon Plank Road by Sharon Bright Holub; Reminiscences of General Herman Haupt by Herman Haupt; and Doctors in Blue: The Medical History of the Union Army in the Civil War by George Worthington Adams. The Personal Memoirs of John H. Brinton, Major and Surgeon U.S.V., 1861-1865 detailed for me some of the history behind the founding of the Army Medical Museum, which eventually became the National Museum of Health and Medicine. Also, his captivating observations about battlefield rigor mortis enlivened the aftermath of battles more than almost any other detail that I read. The six-volume Medical and Surgical History of the War of the Rebellion, first encountered at the National Archives and later through interlibrary loan, provided critical medical information. My special thanks to the Journal of Forensic Sciences, Volume 51, Issue 1, pages 11-17, "The Effects of Chemical and Heat Maceration Techniques on the Recovery of Nuclear and Mitochondrial DNA from Bone," for the methods and list of chemicals that might have been employed to skeletonize bone.

Historians and rangers at the National Parks of Gettysburg, Antietam, Ford's Theatre, and Bull Run were helpful not only with verifying obscure points of history, but also in directing me toward primary doc.u.ments that proved pivotal, especially Herman Haupt's memoir. Frank Cucurullo at Arlington House not only educated me as to the significance of the site, but also read a chapter of the book and made suggestions. The director of the National Museum of Civil War Medicine in Frederick, Maryland, George Wunderlich, spent time on the telephone with me early on in my research. I am also grateful to Terry Reimer, director of research at the museum, for her generosity. In addition, the museum's exhibits helped in visualization of battlefield care. Also, the National Museum of Medicine at Walter Reed has a wonderful Civil War exhibit. The Albany Inst.i.tute of History and Art's archives yielded critical information on nineteenth-century Albany. To Erin McLeary, Michael G. Rhode, Brian F. Spatola, and Franklin E. Damann, curator, Anatomical Division, National Museum of Health and Medicine, Armed Forces Inst.i.tute of Pathology, thank you for helping me track down information on bone preservation. Special thanks to the Town of Colonie historian, Kevin Franklin, for information on Ireland's Corners, or Loudonville, as it is currently known. And to Kathy Sheehan of the Rensselaer County Historical Society, thank you for walking me around the historic district of Troy, New York. Many thanks to James Dierks of the New York Museum of Transportation for answering my questions regarding transportation speeds in the nineteenth century. More thanks to Martha Gude, Roger S. Baskes, Joan R. McKenzie, and Jane Estes.

When I read in Louisa May Alcott's account of her brief tenure at the Union Hotel Hospital in January of 1863 that a rat had nested in her clothing and stolen even the meager amount of food that she had purchased at a corner grocer and set aside for herself in hope of augmenting the paltry army hospital diet, I knew I had a view into the dest.i.tute conditions under which both the nurses and patients were suffering. I acknowledge that I was perhaps a bit hard on Dorothea Dix, though I believe I portrayed her as she was perceived at the time. I am happy that history has revealed her courage and independence.

For insight into President Lincoln, his whereabouts and state of mind, I consulted a variety of sources. An account of a conversation between the president and Willie's nurse related Lincoln's sudden crisis of faith. John Hay's diary yielded additional perception. The Lincoln Log, published online by the Lincoln Presidential Library, was incredibly helpful, and I turned to it again and again. (It was also my deep pleasure to be able to contribute, in a small way, to this invaluable resource.) I took artistic license as much as I could when it served the story. Of special note, while I stayed true to the public record of Lincoln's activities, I did move the president approximately a quarter of a mile into Arlington House, a license I hope Frank Cucurullo will forgive me. In addition, though the questions on the Sanitary Commission officer's form were taken directly from the actual form, I invented the answers; their report on the Union Hotel is, however, quoted verbatim. And while Appleton's Guides did exist, I made up the entry for Washington, because the true entry wasn't interesting enough.

And finally, to all the women of the nation who braved disease, despair, devastation, and death to nurse in the Civil War hospitals, we owe our endless thanks. Nearly twenty women became physicians after their experiences nursing in the Civil War; it is to honor them and their collective experience that Mary Sutter lives. The willing sacrifice of their own health and well-being to serve the men debilitated by the war deserves our commendation and admiration, but especially our remembrance.

Chapter One.

"Are you Mary Sutter?" Hours had pa.s.sed since James Blevens had called for the midwife. All manner of shouts and tumult drifted in from the street, and so he had answered the door to his surgery rooms with some caution, but the young woman before him made an arresting sight: taller and wider than was generally considered handsome, with an unflattering hat pinned to an unruly length of curls, though an enticing brightness about the eyes compensated. "Mary Sutter, the midwife?" he asked.

"Yes, I am Mary Sutter." The young woman looked from the address she had inscribed that afternoon in her small, leather-bound notebook to the harried man in front of her, wondering how he could possibly know who she was. He was all angles, and his sharp chin gave the impression of discipline, though his uncombed hair and unb.u.t.toned vest were damp with sweat.

"Oh, thank G.o.d," he said, and, catching her by the elbow, pulled her inside and slammed the door shut on the cold April rain and the stray warble of a bugle in the distance. James Blevens knew Mary Sutter only by reputation. She is good, even better than her mother, people said. Now he formed an indelible impression of attractiveness, though there was nothing attractive about her. Her features were far too coa.r.s.e, her hair far too wild and already beginning to silver. People said she was young, but you could not tell that by looking at her. She was an odd one, this Mary Sutter.

A kerosene lantern flickered in the late afternoon dimness, revealing shelves of medical instruments: scales, tensile p.r.o.ngs, hinged forceps, monaural and chest stethoscopes, jars of pickled fetal pigs, ether stoppered in azure gla.s.s, a femur bone stripped in acid, a human skull, a stomach floating in brine, jars of medicines, an apothecary's mortar and pestle. Mary could barely tear her eyes from the bounty.

"She is here, at last," the man said over his shoulder.

Mary Sutter peered into the darkness and saw a young woman lying on an exam table, a blanket thrown across her swollen belly, betraying the unmistakable exhaustion of late labor.

"Excuse me, but were you expecting me?" Mary asked.

"Yes, yes," he said, waving her question away with irritation. "Didn't my boy send you here?"

"No. I came to see you on my own. Are you Dr. Blevens?"

"Of course I am."

Now that the time had come, Mary felt almost shy, the humiliation of her afternoon rearing up, along with the anger that had propelled her here, looking for a last chance. On her way, she had waded through crowds, barely conscious of a mounting commotion, lifting her skirts out of the mud, struggling past the tannery and the livery, finally arriving at the two-story frame building with its unpainted door and narrow, steep stairs, so unlike the echoing marble hallways where she had just been refused entry. And all the while, newspaper boys had been yelling Extra! and tributaries of people had been trickling toward the Capitol, and still she had pressed on.

"Dr. Blevens, I came here today-" Mary stopped and exhaled. All the hope of the past year spilled over as she stumbled over her words. "Today I sat in the lobby of the medical college for four hours waiting for Dr. Marsh, and he didn't even have the courtesy to see me." Mary shut out the memory of her afternoon spent in the unwelcoming misery of the Albany Medical College, where after several hours the corpulent clerk had finally hissed, Dr. Marsh no longer wishes to receive letters of application from you, so you are to respectfully desist in any further pet.i.tion.

"When he refused to see me, I decided to come and ask something of you," Mary said.

"Would you mind asking me later?" Blevens asked, propelling Mary toward the young woman. "I need your help. This is Bonnie Miles. Her husband dropped her here early this afternoon. He said she has lost a child before-her first. I think the baby's head is stuck."

Mary pulled off her gloves and unwrapped her shawl, her quest forgotten for the moment, all her attention focused on the woman's exhaustion and youth. Bonnie was small-boned, tiny in all her features, too young, Mary thought, perhaps fifteen, maybe seventeen. Her hips were too narrow, which might be the problem Dr. Blevens had encountered.

"Have you been laboring long?" Mary asked.

The doctor answered for her, speaking quickly and nervously. "She cannot say. Since the night, at least."

Mary lifted her gaze from the girl to appraise the doctor with a cool, steady glance. "No chloroform, no forceps?"

"Why do you think I called you? I've seen enough of the damage those can do. I'm a surgeon, for G.o.d's sake, not a butcher. Please," the doctor said, "I need your help." Of late, surgeons had entered the obstetrics trade, but there had been too many mistakes to make him feel comfortable. He didn't like administering chloroform to ease the mother's pain, because babies ended up languishing in the womb, and doctors had to go hunting for them with forceps. Too many women had bled, too many babies' skulls had been crushed. He would stick with the ailments of men: hatchet blows and factory burns.

"You'll help me?" the girl asked.

As Mary smoothed the blanket, she thought that the girl resembled Jenny, though she lacked Jenny's distinguishing clarity of skin. But the wide-set eyes, the high cheekbones, and the bright lips had emerged from the same well of beauty as Mary's twin. Once, when Mary was very young, she had asked her mother what "twin" meant, and her mother, who had understood the root of the question, had answered, G.o.d does not give out his gifts equally, even to those who have shared a womb.

"My last one died," Bonnie said, whispering, drawing Mary close to her, her face transforming from a feverish daze to one of grief.

"I beg your pardon?"

"The baby before this," Bonnie said, her eyes half closed. "I didn't know it was labor I was taken with, you see?"

The ignorance! It was exactly like Jenny. But Jenny's ignorance was something altogether different, a refusal to engage, to exert herself. A lack of curiosity.

Outside, above the street clatter of carriages and vendors came the hard clang of the fire bell, and cries of "On to the South!"

Blevens rushed to the window and threw it open as Mary whispered to Bonnie not to worry. The rising strains of a band joined the bugle, producing a festive, off-tune march that beckoned like a piper. A swelling crowd hurried along the turnpike, shoulders and wool hats bent against the rain. In the distance the flat pop of gunfire sounded.

"You there! h.e.l.lo? Can you give me the news?" Blevens cried.

A man who had stopped to don an oilskin looked up, revealing a slick, battered face, pocked, the doctor was certain, at the ironworks where the spitting metal often scarred workers' faces.

"Haven't you heard?" the man shouted. "The Carolinians fired on Fort Sumter!"

"Has Lincoln called for men?" the doctor asked, but the scarred man melted into the stream of revelers pushing down the muddy turnpike toward the music as if something were reeling them in. James Blevens slammed down the window and turned.

"I cannot believe it," he said. "It is war."

Bonnie seized Mary's wrist, and Mary said, "Do you want to scare her?"

"Sorry," Blevens said, but he was agitated, glancing again toward the window.

"I'll need scissors, lard, and any rags you have," Mary said. "And water."

With a last look over his shoulder, Blevens scurried to a.s.semble the requested supplies. Bonnie nodded off into the deep sleep that overcame women between contractions. Mary probed her belly, feeling for the baby's spine. Often it was the baby's position in the womb that caused delay. There were also other reasons, worse reasons, that Mary did not yet want to entertain. Look first, her mother always said, for the common.

Bonnie was thin-undernourished even-but even through that thin wall of belly, Mary could not detect the rope of spine she was looking for.

"Bonnie."

The girl snapped from her deep sleep and fixed her gaze on Mary.

"I have to put my hand inside you. Do you understand? I have to confirm where the baby's head is."

The girl nodded, but Mary knew that she did not understand. "You keep looking at me, do you understand? Don't close your eyes."

Mary slipped her hand into the warm glove of Bonnie's body and began to probe the baby's head for the telltale V, where the suture lines of the scalp met in ridges at the back. Bonnie's water had not yet burst and Mary worked gingerly, pressing gently against the bulging sac around the baby's head, taking care not to snag the membrane. Yes, there was the V. She ran her hand along the lines, keeping Bonnie's gaze locked on hers, smiling encouragement as she searched for the obstacle.

"Bonnie," Mary said gently, withdrawing her hand, wiping it on a rag. "Your baby is coming out face up. That's why you're having so much trouble. I have to turn the baby. It will make things easier for both of you. It's going to be uncomfortable, but I'll do it quickly."

Mary nodded to Dr. Blevens; at her summons, he strode across the room and took Bonnie's hands in his. Mary slipped again inside Bonnie and slowly fitted her fingers around the baby's skull. With her other hand, she felt through the abdominal wall for the baby's arms and legs. She established a grip. She was standing now, her right hand deep inside Bonnie, the other on her belly. The wave of contraction hit hard. Bonnie's mouth moved, but no sound came out. Dr. Blevens was leaning forward, his face inches from Bonnie's, whispering encouragement into her ear. When the contraction relaxed, Mary grasped the baby's skull and made a percussive shove with her left, rolling the baby in a wave. Bonnie writhed under the abuse, arching her back off the table, then falling again. Through the tidal swell of the next two contractions, Mary held the child in place, keeping the baby locked in its new position, the muscled womb clamping down on her fingertips. From outside, Mary could hear more shouts, but even these could not distract her now. All her movements, decisions, and thoughts came from a well deep inside her. When she was certain that the baby would not roll back, she carefully withdrew her hands, and the rest of the delivery proceeded. Mary looked only at Bonnie, thought only of Bonnie and the baby. She was authoritative when Bonnie faltered, stern when she panicked, and unflagging when, screaming, Bonnie expelled a boy in a rush of amniotic fluid. Mary wiped the small flag of his gender along with the rest of him, and then swaddled him in a blanket that the doctor handed her. There was no deformation. The child was perfect, if small. She judged this one at nine months' gestation, but maybe less.

"Extraordinary. I was certain the head was too large," Blevens said.

"It's a common enough mistake."

Efficient but tender, Mary went about her work with a kind of informality. She tucked the mewling infant into Bonnie's grateful arms and tied off the cord after the afterbirth slithered out. There was little blood. The girl had not even torn.

"It's the lard," Mary said, wiping her soaked skirts with a towel. "Ma.s.sage it into the flesh beforehand, a bit at a time."

Blevens tucked in the ends of the blanket that had fallen away, but he knew it to be an insignificant contribution, the act of a maiden aunt after the danger had pa.s.sed.

"Do allow me to pay you," he said, but Mary dismissed this offer with a wave of her hand.

"Where is her husband?" Mary asked.

"I don't know. He ran in with her and then left." Blevens looked around the room as if the boy might suddenly appear.

"But where will she go?"

Blevens shrugged. His rooms were not made for keeping patients overnight.

"If you like, I can take her home with me. My mother and I have a lying-in room. She can stay with us until she's recovered."

He protested, and Mary shook it off as if it were nothing, but James Blevens knew it wasn't nothing. The girl and her husband were poor farmers. James had surmised that much when the boy had dropped Bonnie off. They would never be able to pay for any care, not even room and board. Her offer was very generous, more generous than James had any right to expect given that she had been called in at the last minute. But now he recalled the earlier confusion.

"Miss Sutter, what was it you wanted from me this afternoon?"

Mary wiped her hands on her ruined skirts. Her birthing ap.r.o.n was at home, along with the rest of her medicine, rubber sheets, scissors, and rags. "You have already seen me turn a child. I am just as skilled with a previa, or twins. But I want more. I want to study. I want to know more about anatomy, physiology. The something I cannot see." It was the speech she had meant for Dr. Marsh. She began to speak in a rush, the words tumbling out. "For instance, the problem of why some women seize in labor. I know that headaches and light sensitivity precede it, but do they trigger it? Is it like other seizure disorders? I know that sometimes it's caused by a rapid revolution of blood to the head, or a too severely felt labor, but why? I was reading in The Process of Parturition-"

Dr. Blevens swiveled to look at his bookshelf and then turned back to her. "Aren't deliveries enough for you?"

Mary's gaze was covetous. "I want to understand everything," she said. "Isn't it all connected? Isn't the body a system? How can I understand a part if I do not understand the whole?"

Mary recognized Blevens's look: the tilting of the head, the gaze of incredulity. Why was she always such a surprise to people? In her childhood her father had often greeted her questions-Is the Hudson's tidal nature a detriment or a help to transportation? What is the height of the world's largest mountain? What is the true nature of the earth's center?-with exhalations of astonishment.

"Miss Sutter, what precisely do you want?"

"I want to become a doctor. The Albany Medical College won't admit me. I want you to teach me."

"I beg your pardon?"

"Many fine doctors have only apprenticed-"

"Miss Sutter-"

"Consider what you just saw, what I just did for you. I work hard. You would not be disappointed. And I could teach you midwifery!" This is it, Mary thought. I have to convince this man.

Blevens could understand the young woman's enthusiasm for medicine, and he wondered now what William Stipp would make of her. She was nearly as windblown and desperate as Blevens had been a decade ago, when he had accosted Stipp much the way Miss Sutter was accosting him now.

Blevens sighed and said, "I am terribly sorry, but what you propose is impossible."

"It is not impossible."

"It is. I'm going to enlist. They'll need surgeons."

"But you don't know what will happen. You don't know. Maybe this is the end, maybe it's all over-"

"Have you gone mad? The war has just started!"

The baby began to cry and James Blevens cursed. They had been whispering, trying not to disturb Bonnie.

Blevens said, "I am most grateful to you today for your help, and I will pay you, but I cannot-"

"But you can," Mary said. "Dr. Blevens, if you take me on-"