Chapter 22
Dr. Edward Robitzek
November 1940
Dr. Edward Robitzek opened the door and stepped into the low-lit, musty morgue at Sea View, leaving behind the bluster of a freezing winter day. Inside, he blew into his hands before unbuttoning his woolen coat and hanging it on a hook. Still feeling the chill from outside, a nip that would continue all afternoon, as the morgue itself always leaned cold, he pulled out a clean surgical gown and unfurled it.
As he dressed, his mind sometimes wandered to different things: his career, his new wife, a book he was reading, tuberculosis, and the war. It was November 1940, more than a year since Hitler had invaded Poland, and things were deteriorating. Tanks and bombers now annihilated Europe, and nation after nation—Denmark, Norway, the Netherlands, Belgium, and France—fell to the Nazis. He pushed this thought aside, knowing it could easily consume all others, slipped a pair of rubber gloves over his hands, and moved the tray table with his equipment to the center of the room, toward the body on the table.
It was small and frail, and in the dim light, the waxen face looked peaceful, almost pretty. The lashes were long, and the hair fell in long strands, hiding the wooden block that supported the neck.
As the hospital’s newest doctor, the tall and lanky twenty-seven-year-old, with movie-star good looks, was putting in twelve-hour shifts, and even those weren’t enough to manage the bodies arriving on gurneys at all hours. He was tired, and before starting, he paused and took off his glasses, revealing sky-blue eyes shadowed by dark circles. The left one felt especially fatigued; it always did, as it compensated for his right one, left blind by a childhood injury. He closed them and with his index finger and thumb squeezed the bridge of his nose to relieve some of the strain.
According to the case report, the body on the table belonged to M.L., a sixteen-year-old Puerto Rican female. Admitted two years earlier with pulmonary tuberculosis, M.L. had undergone a series of operations. The most recent was a phrenic nerve crush, a procedure where doctors cut the phrenic nerve on one side of the neck to temporarily paralyze half the diaphragm, the primary muscle responsible for inhaling and exhaling. When cut, the diaphragm ceased contracting, leaving the lung static, or at rest. Doctors hoped that in this immobile state, the lung might heal. But M.L. had spiked a fever, and two nights ago she had died. Her family consented to an autopsy, hoping their daughter’s lungs could add to Sea View’s growing research on tuberculosis.
Robitzek had always been drawn to pathology, to the interior of the human body; to him, each set of lungs, a part of the brain, a fragment from the spine, or a cord from the larynx provided another clue in the seemingly never-ending mystery that was tuberculosis. “The human body never lies,” he always said, and maybe through all these pieces of livers, kidneys, brains, lungs, and intestines, he could uncover new truths about this disease, understand how it manifested in and through the body, and why it spread. Only then could a cure happen.
Born in the Bronx in 1912, Robitzek was the only child of Kate and Arthur Robitzek. He was a quiet kid, smart and curious, who enjoyed spending time with his parents, especially his father, a generous gentleman, who co-owned a prosperous coal company with his two brothers. Their profits enabled all the brothers to buy homes with lawns and servants, vast kitchens, guest bedrooms, and stunning views. Life was good for the brothers Robitzek, until 1922, when the dread disease arrived in Arthur’s home.
The diagnosis shocked the family. Tuberculosis wasn’t supposed to breach the lungs of a healthy and wealthy forty-five-year-old man like Arthur. He lived in a large, clean house, ate good food, and exercised, and his job kept him mostly outdoors. According to the thinking of the time, Arthur Robitzek had nothing in common with the typical victims of tuberculosis, but the bacteria had found him anyway.
His doctor suggested going to a sanatorium to rest and hopefully heal. Sea View was twenty-three miles from the family’s home, allowing for easy visits from his wife and son, but his doctor refused to admit him. Men of Arthur’s status went to the Trudeau Sanatorium in Saranac Lake, a small, private, boutique-like sanatorium founded by Dr. Edward Livingston Trudeau in 1885. Stricken by tuberculosis, Trudeau had originally gone to this remote lake, tucked hundreds of miles away in the Adirondack Mountains, hoping to die amid crystal brooks and tall, swaying trees, but instead of dying, he was healed. Fifty-five years later, his place, with its quaint cottages and philosophy that the cure was “not a hospital stay, but a way of life . . . a conversion to a nearly religious regimen of health,” had become world renowned. Over the years, it had attracted the likes of novelist Robert Louis Stevenson, New York Giants pitcher Christy Mathewson, a litany of vaudeville stars, and now Arthur Robitzek.
He arrived in autumn 1923, tired and weak and much too thin. His cottage room was small and rustic, with a dresser and a twin bed covered with a patchwork quilt, and his shared wooden porch faced the forest, where trees blazed with fall colors. Upon admittance, he received the standard booklet, Getting the Most out of Your Cure, outlining his role in getting well and the sanatorium rules. The entire place, all of it, was a radical departure from his stately home, with its large, well-furnished rooms, but he was grateful and eager to get well.
Arthur was a good patient, diligently following Trudeau’s regimen: rest and long periods of time sitting outside in a ’Rondack Reclining Chair, a combination bed and chair specially designed to make the prescribed bed rest more comfortable. As he improved, Arthur spent his “chair time” writing long letters to his son, telling him about foxes and deer and how he was “feeling better.” Finally, he wrote about “coming home cured.” Later in life, Robitzek would recall his father’s letters and realize how naïve the word “cure” sounded, how it was a relative term, almost absurd.
Six months later, Arthur was discharged, with orders to live a healthy lifestyle and follow the rest-cure regimen at home. Two years passed, Arthur was feeling healthy, his strength had returned, and tuberculosis began receding from the Robitzek family. Then one day, he spiked a fever, followed by a cough and lethargy and loss of appetite. The second diagnosis fell hard: laryngeal tuberculosis. This, he learned, was more contagious than the original diagnosis of pulmonary tuberculosis. It was also far more cunning and difficult to treat.
Arthur weighed his options. He didn’t want to return to Saranac Lake and spend his days lounging in ’rondack recliners and sleeping under patchwork quilts; nor did he want to try any invasive surgical procedures at Sea View. Rather, he wanted to live his remaining time at home, surrounded by his family. But death was cruel to Arthur. It came slowly in a drawn-out process that tormented him and his wife and his sixteen-year-old son.
Recalling those days watching his father’s demise, Robitzek remembered how the disease transformed him from a robust middle-aged gentleman into a wheezing old man with unresponsive eyes and indented cheeks. For weeks, young Robitzek sat beside his father, watching his rib cage heave and cave, knowing that soon it would seize up; that those thick fluids moving around would stop churning, and the man he loved most would choke to death.
On May 1, 1929, with his wife and teenage son sitting beside him, Arthur took his last breath. Three days later, on a gloomy morning, Robitzek followed his father’s casket, draped with sprays of roses, lilies, gladioli, and carnations, through the vast acres of Woodlawn Cemetery in the Bronx. There they laid Arthur to rest in the same ground as Herman Melville, Nellie Bly, and suffragist Elizabeth Cady Stanton.
His father’s death was wretched, altering the course of his life. Instead of pursuing a degree in accounting and joining the family business, he took premed courses at Colgate University. After graduating, he enrolled in New York’s Columbia University College of Physicians and Surgeons to study chest diseases. It was there, while struggling with an organic chemistry class, that his professor told him, “You will never be a doctor,” a remark Robitzek never forgot.
He finished in 1938, graduating with top honors, and took a rotating internship at Fordham University. As part of his training, he spent a year riding in ambulances.
The new Ford ambulance was sleek and streamlined, able to cut through New York City’s congested avenues fast. Its siren was loud, blaring over the constant clamor of horns, trolley bells, jackhammers, and elevated trains that blanketed the city. Robitzek worked night and day—in 1938 alone there were over four hundred thousand ambulance calls in the city. He attended to car accidents, heart attacks, robberies, stabbings, domestic fights, children tumbling out of windows, and fires.
Sometimes he would watch as firemen swung their ladders ten or twelve stories high and, laden with equipment, climbed up into burning buildings. Minutes later, they’d emerge with limp bodies draped in their arms for him to save. Kneeling above the victims, Robitzek would cut open their shirts and perform chest compressions and mouth-to-mouth resuscitation, his own mouth filling with the taste of smoke and ash.
Other times, he was called to terrible accidents where bodies were pitched and tossed, their bones snapped in half. He managed the victims’ pain and secured the broken bones with splints. At night in bed, his back ached from lifting hundreds of pounds of dead weight onto stretchers and loading them into the back of the ambulance, and then crouching under its low-pitched roof, trying to keep the victims alive. But he was grateful for the experience: “It exposed me to everything medical,” he said.
He finished his ambulance service in 1939, the year Hitler marched into Poland and instructed his generals to “darken the skies over Warsaw with falling bombs and drown the people in blood.” Seeing the devastation wrought by the German Heinkel and Junkers bombers, many American doctors felt compelled to offer their service either abroad or stateside.
The young Robitzek immediately joined thousands of his colleagues and registered for the draft, hoping to serve his country as a medic. But he learned the US military didn’t want men with one good eye. The rejection outraged him: “It was the stupidest thing,” he would later say. “They should know that having one eye as a diagnostician is different from having one eye as a sniper.”
And so here he was, at Sea View, fighting an altogether different war. After being rejected by the military, the newly minted doctor had accepted a one-year post as a resident pathologist.
His boss at Fordham thought it was a peculiar choice for a promising young doctor with so many options. He could stay at Fordham or transfer to the prestigious Cornell University Medical College or Lenox Hill, or any hospital besides Sea View. His colleagues, too, thought it odd. Most of them avoided the hospital on the hill unless it was necessary for their training. Aside from the commute, few found pleasure in spending their days with over 1,500 infected patients for no pay.
Since its inception, Sea View had always relied on the altruism of doctors to offer their services once or twice a week in exchange for experience and research opportunities. Many turned it down. But for Robitzek, the research without pay was part of the lure: “No disease,” he believed, “especially tuberculosis, should be about capital.”
During his father’s illness, he saw firsthand how the wealthy, his father included, were deemed worthy of good medical treatment, while others, based on their socioeconomic standing, were denied it. They were sent off to crumbling institutions like Sea View or Harlem Hospital. The disparity was grotesque, “as if disease discriminated,” he’d said. In his own practice, he strove for objectivity and humility, focusing on the individual facts and how they eventually connected to a bigger picture about sickness, its manifestation, its trajectory, and its end results. At Sea View, that bigger picture was blinding.
Robitzek looked at the teenage girl on the table, at her skin stretched tautly across her bones like a translucent sheath, revealing hundreds of small veins, all deflated and useless. Her ribs, or what remained of them, protruded upward like rungs on a ladder, and her arms were reed-thin and rigid. He lifted his hand and placed it on the girl’s forearm. The skin was cold and clammy. Keeping it there, he moved his good eye up and down her arm, noting all the bruises, big purple blotches from the thick steel needles that had pierced and punctured her veins and muscles every day. The bruises snaked down her arm to her hands, where slender fingers led to pretty nails that the nurses sometimes helped to paint.
He was often struck by the nail polish or any other personal cosmetic choice. Every day, people deliberated over minute decisions: dark or light red lipstick, brown or black hat, long or short nails, bearded or clean shaven, black or tweed coat. Trivial decisions, really. But he knew the power of these tiny details, how they latched on to memory and later emerged in whispers of Remember this or Remember that. After his father’s death, it was the bowler hat hanging on the hallway peg that often sparked his grief.
He leaned forward and sank the blade into the skin by the left shoulder and dragged the knife down, curving under the breast, to the center of the chest; he repeated the process on the right side, but instead of stopping, he continued moving the blade vertically down the middle, around the belly button, until he reached the pubic bone. There he stopped. He regarded the Y-shaped incision.
Grasping the skin flap by the shoulder, he pulled it back, and a rush of air came out. It was fetid and the stench filled the room. He reached for the rib cage, removed it, and saw the chest cavity full of straw-colored fluid, pus mixed with blood and other liquids.
Bending over the exposed chest, he slid his gloved fingers under the right lung. It slipped away. Repositioning himself, he tried again, but the organ kept sliding away from him, sinking back into the infected fluid. Eventually it gave way, and he grasped one lung, then the other, and cut them free.
He felt their weight in his palm. They were heavy and distended, like two sopping sponges, and they oozed a frothy white mucoid fluid. He placed them on a silver tray and then glanced at the other organs, the heart, which looked pale and flabby, and the spleen and liver, which both seemed smaller than normal. Later, he would pull them out and assess them, but now he wanted to look at the lungs. Wiping his gloved hand on a towel, Robitzek pulled up a chair and began his examination.
He loved this part of his job.
In the morgue, away from the clamor and rush of the hospital ward, the blue-eyed doctor fell into a reflective state; he spent long moments lingering over the organs, contemplating their final shape and composition.
Normally smooth and pink and cone-shaped, the lungs are one of the largest organs in the human body. Spread out, their surface area is the size of half a tennis court, and every day they bring in about two thousand gallons of air, enough to fill a swimming pool. This air moves through an intricate network of airways, smaller and larger passages, whose combined length is about 1,500 miles, the distance from Savannah to Staten Island and back. But beyond these facts, Robitzek was most captivated by their role in immunity.
When a microbe like tuberculosis reaches the lungs, the body mounts its defense, sending out macrophages, large white blood cells that surround, capture, and destroy the harmful organism. Ninety percent of the time, the cells manage to trap the bacteria, either killing it or holding it in a dormant state behind a kind of wall; the only sign of its presence would be a minor bump on the smooth surface of the lungs. But for 10 percent of the population, the body’s defenses fail and the microbe breaks through the wall. Once free, it spreads and finds a place to settle and grow and then destroy.
The girl’s lungs, splayed out, were a mess of scars, dead tissue, and cavities, giant holes where the bacteria had lived, where it chewed away at the membranes, leaving them frayed like the tattered threads of an old garment. Robitzek touched their surface. It was rutted, pockmarked with dips and hollows and voids. Of the two lungs, he noted the right one was in worse condition; the cavities were larger, and from its raggedy edge, he noticed a burst blood vessel hanging. With the tip of his finger, he touched it and followed its pathway. It led him to the center of the hole. There was the cause of death: a hemorrhage. Below it were more cavities, some tiny as pinholes and others large as golf balls; surrounding them were more dead nerves and tissue in varying hues of gray, maroon, and black.
He was awed by the power of the microbe, by its ability to mutilate. What had compromised her immune system? Why had she fallen ill? Why had treatment failed? These questions dogged him as he trimmed off some lung tissue. Tomorrow he would process the samples, mount them on slides, and view them under a microscope, comparing notes from previous autopsies and logging any new information. Maybe from the ruins of this girl and hundreds of others, he could help create something good and add to the science that might lead to a successful drug. He moved his feet, pushed back his chair, and placed the lungs back into her chest cavity. He repeated the procedure with the heart and liver and spleen, removing an organ and then replacing it. When he was done, he put back the rib cage, pulled down the skin, smoothed it out, and began stitching her up.
The job didn’t require intense concentration, and his mind flitted over other thoughts: his father or the disease or his wife, Katherine—he always thought of her—or the Romantic poets. He loved the works of those young nineteenth-century men and women, like John Keats, Edgar Allan Poe, and Charlotte Brontë, who penned long paragraphs and stanzas about tuberculosis as something sacred. They lauded the disease for its emotional intensity, for its power to unleash creative transcendence, for its furious fevers that became like a holy fire, inspiring them to higher realms of imagination.
Victims of the epidemic themselves, they wrote about their suffering in majestic terms: their lips trembled; their cheeks glowed; and the blood they coughed up was akin to a gorgeous crimson liquid. For the composers Giacomo Puccini and Giuseppe Verdi, tuberculosis was the operatic fate of lovely heroines. “Decay and disease are often beautiful . . . like the hectic glow of consumption,” said Henry David Thoreau, another victim of the disease. And Lord Byron, the flamboyant and passionate politician turned poet, stated without irony, “I should like to die from consumption.”
Now, standing in a basement morgue next to a hulking freezer full of bodies, Robitzek thought describing the disease in such rhapsodic terms seemed not only ludicrous but downright profane. He pulled up the sheet and covered the young girl.
Stopping this would require drugs. Powerful ones. Currently, pharmaceutical companies were compounding and releasing new variations of sulfa drugs, safer ones, more streamlined for specific infections. Perhaps soon they would discover one that worked against TB, one that could penetrate its cell wall, stop it from replicating, and close the cavities without poisoning the body.
But until there was something better, all he could do was pull out organs and then study them. Nothing more. He opened the freezer and slid the body inside, then shut the door.